Diagnosis of sinusitis in adults: History, physical examination, nasal cytology, echo, and rhinoscope

doi:10.1016/0091-6749(92)90165-X

Journal of Allergy and Clinical Immunology

Volume 90, Issue 3, Part 2, September 1992, Pages 436-441

https://doi.org/10.1016/0091-6749(92)90165-X Get rights and content

Abstract

The symptoms of sinusitis are common and overlap other diseases ranging from common colds to perennial rhinitis. When symptoms are prolonged and interfere with daily living, an appropriate set of investigations are indicated. The workup is designed to detect both the presence and extent of any disease in the paranasal sinus cavities. In chronic sinusitis, a constellation of nonspecific symptoms such as facial pressure, headache, nasal obstruction, and drainage may occur. Physical examination is important to exclude anatomic causes of symptoms. A negative physical examination does not rule out the diagnosis. Adjunctive tests in selected cases include nasal cytologic studies, ultrasound studies, and the use of flexible or rigid nasal endoscopes, in addition to imaging tests such as radiology and computed tomography.

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The Use of Flexible Rhinolaryngoscopy for Allergy-Immunology Practice
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The rigid endoscope is another powerful tool that can facilitate an evaluation of the nasal cavity. It provides improved optics and visualization of the nasal cavity, especially the nasopharynx and posterior pharyngeal wall compared with F-RLS.11,13 Moreover, the rigid endoscope enables the examiner to use another instrument without the need for an assistant.
Flexible rhinolaryngoscopy is an underused procedure that can provide allergists-immunologists and other physicians with several benefits over existing imaging techniques. In this article, we highlight the many benefits of flexible rhinolaryngoscopy and expand on its safety, cost-effectiveness, and convenience. This article also covers current procedure techniques and assesses the most common indications and relevant clinical findings for which flexible rhinolaryngoscopy can be used to evaluate the nasopharyngeal tract. Videos for the clinician showing some of the most common findings are included.
Cytologic and Microbiological Examination of Secretions From the Paranasal Sinuses in Horses and Other Species
2018, Journal of Equine Veterinary Science
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Studies in human medicine comparing the results of nasal cytology with those of sinus radiography had good sensitivity in predicting sinus disease using neutrophils counts [108,109]. However, these studies lack the comparison of nasal cytology to sinus aspiration [110]. Araujo et al [91] compared middle meatus secretions collected endoscopically in patients with CRS and healthy individuals and concluded that the microbiology of the middle meatus is similar in both groups.
Only sparse literature has been published on the microbiological and cytologic examination of secretions from the paranasal sinuses in horses, and the data that are available consist mainly of results in single animals or small case series. Contrarily, the role of bacteria in sinusitis in humans has been the topic of several studies and reviews. We aim with this review to summarize the current knowledge on the characteristics and microbiological and cytologic composition of paranasal sinus secretions in equids in comparison to humans and selected domestic animals.
Rhinosinusitis diagnosis and management for the clinician: A synopsis of recent consensus guidelines
2011, Mayo Clinic Proceedings
Rhinosinusitis (RS) affects approximately 1 in 7 adults in the United States, and its effect on quality of life, productivity, and finances is substantial. During the past 10 years, several expert panels from authoritative bodies have published evidence-based guidelines for the diagnosis and management of RS and its subtypes, including acute viral RS, acute bacterial RS, chronic RS (CRS) without nasal polyposis, CRS with nasal polyposis, and allergic fungal RS. This review examines and compares the recommendations of the Rhinosinusitis Initiative, the Joint Task Force on Practice Parameters, the Clinical Practice Guideline: Adult Sinusitis, the European Position Paper on Rhinosinusitis and Nasal Polyps 2007, and the British Society for Allergy and Clinical Immunology. Points of consensus and divergent opinions expressed in these guidelines regarding classification, diagnosis, and management of adults with acute RS (ARS) and CRS and their various subtypes are highlighted for the practicing clinician. Key points of agreement regarding therapy in the guidelines for ARS include the efficacy of symptomatic treatment, such as intranasal corticosteroids, and the importance of reducing the unnecessary use of antibiotics in ARS; however, guidelines do not agree precisely regarding when antibiotics should be considered as a reasonable treatment strategy. Although the guidelines diverge markedly on the management of CRS, the diagnostic utility of nasal airway examination is acknowledged by all. Important and relevant data from MEDLINE-indexed articles published since the most recent guidelines were issued are also considered, and needs for future research are discussed.
Diagnosis of Nonodontogenic Toothache
2010, Cohen's Pathways of the Pulp, Tenth Edition
Nasal and sinus endoscopy for medical management of resistant rhinosinusitis, including postsurgical patients
2008, Journal of Allergy and Clinical Immunology
Citation Excerpt :
Use of endoscopy can also improve diagnostic accuracy and thereby reduce costly and unnecessary medication use (eg, antibiotics). It is highly desirable that all specialists treating nasal and sinus disease be able to perform a complete endoscopic evaluation of the nose and sinuses, especially for evaluation of inflammatory disease.8 Endoscopy should be viewed as part of a complete examination of the nose and sinuses.
Nasal endoscopy has been practiced by allergists since the early 1980s; however, allergists in general have not embraced endoscopic evaluation of patients with sinus disease, either before or after surgery. Allergists are in a unique position to render medical (as opposed to surgical) care of patients with sinusitis. There has been a growing realization that endoscopy is a valuable procedure for the evaluation and medical treatment of patients with difficult sinusitis. This has resulted in the need for a resource to allow allergists to understand the nature of endoscopic findings in patients with sinusitis, either preoperatively or postoperatively. This article introduces the findings at endoscopy that are common in patients with sinusitis, including those that may be seen after surgery. The findings include perforation of the septum, retained secretions, small surgical ostium caused by postoperative ostial stenosis, previous Caldwell Luc procedure, recirculation of mucus, hyperplastic nasal disease, synechiae, recurrent disease in previously unaffected sinuses, empty nose syndrome, frontal sinus disease, dental disease, and other, more complicated entities.
Clinical practice guideline: Adult sinusitis
2007, Otolaryngology - Head and Neck Surgery
Citation Excerpt :
Ciliary beat frequency in mucosa from the nose and paranasal sinuses of patients with CRS showed no difference compared to normal controls, and frequency was increased in specimens recovered from patients with nasal polyposis.181 Early research on the pathogenesis of CRS and recurrent acute rhinosinusitis focused on anatomic abnormalities,184-187 which could obstruct the paranasal sinuses and trigger infection.188,189 Based upon this assumption, descriptions of anatomic relationships, variances, associations with adjacent anatomic regions, and the importance of accurate radiographic data upon surgical planning and intervention have populated the literature.190-195
This guideline provides evidence-based recommendations on managing sinusitis, defined as symptomatic inflammation of the paranasal sinuses. Sinusitis affects 1 in 7 adults in the United States, resulting in about 31 million individuals diagnosed each year. Since sinusitis almost always involves the nasal cavity, the term rhinosinusitis is preferred. The guideline target patient is aged 18 years or older with uncomplicated rhinosinusitis, evaluated in any setting in which an adult with rhinosinusitis would be identified, monitored, or managed. This guideline is intended for all clinicians who are likely to diagnose and manage adults with sinusitis.
The primary purpose of this guideline is to improve diagnostic accuracy for adult rhinosinusitis, reduce inappropriate antibiotic use, reduce inappropriate use of radiographic imaging, and promote appropriate use of ancillary tests that include nasal endoscopy, computed tomography, and testing for allergy and immune function. In creating this guideline the American Academy of Otolaryngology–Head and Neck Surgery Foundation selected a panel representing the fields of allergy, emergency medicine, family medicine, health insurance, immunology, infectious disease, internal medicine, medical informatics, nursing, otolaryngology–head and neck surgery, pulmonology, and radiology.
The panel made strong recommendations that 1) clinicians should distinguish presumed acute bacterial rhinosinusitis (ABRS) from acute rhinosinusitis caused by viral upper respiratory infections and noninfectious conditions, and a clinician should diagnose ABRS when (a) symptoms or signs of acute rhinosinusitis are present 10 days or more beyond the onset of upper respiratory symptoms, or (b) symptoms or signs of acute rhinosinusitis worsen within 10 days after an initial improvement (double worsening), and 2) the management of ABRS should include an assessment of pain, with analgesic treatment based on the severity of pain.
The panel made a recommendation against radiographic imaging for patients who meet diagnostic criteria for acute rhinosinusitis, unless a complication or alternative diagnosis is suspected.
The panel made recommendations that 1) if a decision is made to treat ABRS with an antibiotic agent, the clinician should prescribe amoxicillin as first-line therapy for most adults, 2) if the patient worsens or fails to improve with the initial management option by 7 days, the clinician should reassess the patient to confirm ABRS, exclude other causes of illness, and detect complications, 3) clinicians should distinguish chronic rhinosinusitis (CRS) and recurrent acute rhinosinusitis from isolated episodes of ABRS and other causes of sinonasal symptoms, 4) clinicians should assess the patient with CRS or recurrent acute rhinosinusitis for factors that modify management, such as allergic rhinitis, cystic fibrosis, immunocompromised state, ciliary dyskinesia, and anatomic variation, 5) the clinician should corroborate a diagnosis and/or investigate for underlying causes of CRS and recurrent acute rhinosinusitis, 6) the clinician should obtain computed tomography of the paranasal sinuses in diagnosing or evaluating a patient with CRS or recurrent acute rhinosinusitis, and 7) clinicians should educate/counsel patients with CRS or recurrent acute rhinosinusitis regarding control measures.
The panel offered as options that 1) clinicians may prescribe symptomatic relief in managing viral rhinosinusitis, 2) clinicians may prescribe symptomatic relief in managing ABRS, 3) observation without use of antibiotics is an option for selected adults with uncomplicated ABRS who have mild illness (mild pain and temperature <38.3°C or 101°F) and assurance of follow-up, 4) the clinician may obtain nasal endoscopy in diagnosing or evaluating a patient with CRS or recurrent acute rhinosinusitis, and 5) the clinician may obtain testing for allergy and immune function in evaluating a patient with CRS or recurrent acute rhinosinusitis.
This clinical practice guideline is not intended as a sole source of guidance for managing adults with rhinosinusitis. Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. It is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.

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Diagnosis of sinusitis in adults: History, physical examination, nasal cytology, echo, and rhinoscope

Abstract

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Intl J Pediatr Otorhinolaryngol

J Allergy Clin Immunol

J Allergy Clin Immunol

Nasal polyps and sinusitis

The clinician's veiw of sinusitis

Otolaryngol Head Neck Surg

Paranasal sinus infections

Nasal polyps

The pathogenesis of orbital acute sinusitis

Laryngoscope