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

Diagnosis of sinusitis in adults: History, physical examination, nasal cytology, echo, and rhinoscope Howard M. Druce, MD, FACP St. Louis, MO. 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 nonspectfic 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. (JALLERGY CLINIMMUNOL 1992;90:436-41.) Key words: Sinusitis, rhinorrhea, maxillary, ethmoid, nasal mucosa, sphenoid cytology, A-mode ultrasonography, flexible and rigid endoscopy Almost everyone complains of “sinus.” Patients frequently complain of chronic nasal congestion, postFrom the Division of Allergy and Immunology, Department of Internal Medicine, St. Louis University School of Medicine, St. Louis, MO. Reprint requests: Howard M. Druce, MD, FACP, Associate Professor of Internal Medicine, Assistant Professor of Otolaryngology, Division of Allergy and Immunology, Department of Internal Medicine, St. Louis University School of Medicine, 1402 S. Grand Blvd., R209, St. Louis, MO . l/O/38490 nasal drip, facial fullness, or headaches and are given a diagnostic label of “sinusitis.” Depending on the practitioner, such patients may be treated empirically with antibiotics or antihistamines. Because there are no universally accepted criteria for the diagnosis of sinusitis, no population studies exist to determine the natural history of chronic sinusitis with and without intervention. Interventional studies have generally been restricted to antibiotic choice in acute sinus infections and surgical interventions in chronic disease. Acute sinusitis is generally a bacterial infection that occurs after a viral upper respiratory tract infection CONTINUES...