ear, nose, and throat disorders
Sinusitis
Diagnosis of Sinusitis
Clinical evaluation Sometimes CT Sinus infections are usually diagnosed clinically. Imaging is not indicated in acute sinusitis unless there are findings that suggest complications, in which case CT is done. In chronic sinusitis, CT is done more often, and x-rays of the apices of the teeth may be required in chronic maxillary sinusitis to exclude a periapical abscess. Chronic sinusitis is a common incidental finding in patients who have a head CT for other reasons (eg, patients with headache with or without mild head injury) but is rarely the cause of the patient's symptoms. Microbial cultures are rarely done because a valid culture requires a sample obtained by sinus endoscopy or sinus puncture; culturing a swab of nasal secretions is inadequate. Cultures are typically done only when empiric treatment fails and in immunocompromised patients and some hospital-acquired causes of sinusitis. Sinusitis in children can initially be difficult to distinguish from an upper respiratory infection (URI). Bacterial sinusitis is suspected when purulent rhinorrhea persists for > 10 days along with fatigue and cough. Fever is uncommon. Local facial pain or discomfort may be present. Nasal examination discloses purulent drainage and should rule out foreign body. Diagnosis of acute sinusitis in children is clinical. CT is avoided because of concerns about radiation exposure unless there are signs of orbital or intracranial complications (eg, periorbital swelling, vision loss, diplopia, or ophthalmoplegia), there is chronic sinusitis that has not responded to treatment, or there is concern about rare nasopharyngeal cancer (eg, based on unilateral nasal obstruction, pain, epistaxis, facial swelling, or, particularly concerning, diminished vision). Periorbital edema in a child requires prompt assessment for Preseptal and Orbital Cellulitis and possible surgical intervention to prevent visual impairment and intracranial infection. 