eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Nasal & Sinus Diseases

Sinusitis, Acute, Medical Treatment: Differential Diagnoses & Workup

Author: Steven E Sobol, MD, FRCSC, MSc, FAAP, Assistant Professor, Director of Pediatric Otolaryngology, Department of Otolaryngology Head and Neck Surgery, Emory University School of Medicine; Otolaryngologist-In-Chief, Children's Healthcare of Atlanta at Egleston
Coauthor(s): Melvin D Schloss, MD, FRCSC, Director of Pediatric Otolaryngology, Professor, Department of Otolaryngology, McGill University, Canada; Ted L Tewfik, MD, FRCS(C), Professor, Department of Otolaryngology, Director of Continuing Medical Education of Otolaryngology, McGill University Medical School; Director, Director of Professional Affairs of Otolaryngology, Department of Otolaryngology, Montreal Children's Hospital; Senior Staff, Montreal General Hospital and Royal Victoria Hospital
Contributor Information and Disclosures

Updated: Nov 19, 2009

Differential Diagnoses

Allergic Fungal Sinusitis
Sinusitis, Fungal
Sinusitis, Chronic, Medical Treatment
Sinusitis, Maxillary, Acute, Surgical Treatment
Sinusitis, Ethmoid, Acute, Surgical Treatment
Sinusitis, Maxillary, Chronic, Surgical Treatment
Sinusitis, Frontal, Acute, Surgical Treatment
Sinusitis, Sphenoid, Acute, Surgical Treatment

Workup

Laboratory Studies

  • Some authors have reported on the use of laboratory tests including sedimentation rate, white blood cell counts, and C-reactive protein levels to help diagnose acute sinusitis.4 These tests appear to add little to the predictive value of clinical findings in the diagnosis.
  • Cultures are not routinely obtained in the evaluation of acute sinusitis but should be obtained in a patient in intensive care or with immunocompromise, in children not responding to appropriate medical management, and in patients with complications of sinusitis. Because the nose is colonized with multiple nonpathogenic species of bacteria, care must be taken when evaluating culture results. A specific organism is considered pathogenic when more than 104 colony-forming units of the species are grown on culture or when polymorph counts are greater than 5000 cells/mL.

Imaging Studies

  • Imaging studies are not necessary when the probability of sinusitis is either high or low but may be useful when the diagnosis is in doubt, based upon a thorough history and physical examination. Plain sinus radiographs may demonstrate mucosal thickening, air-fluid levels, and sinus opacification. Limitations of plain films include interobserver variability, inability to distinguish infection from a polyp or tumor disease, and poor depiction of the ethmoid and sphenoid sinuses.
  • CT scanning has poor specificity for the diagnosis of acute sinusitis, demonstrating sinus air-fluid levels in 87% of individuals with simple URTIs and 40% of asymptomatic individuals. CT scanning is the modality of choice, however, in specific circumstances such as in the evaluation of a patient in intensive care, when complications are suspected, or in the preoperative evaluation of surgical candidates. CT scanning can give valuable information regarding the anatomical and mechanical contributions in the development of acute sinusitis. Coronal views with bone windows are the preferred sinus study for evaluating each of the sinuses as well as the ostiomeatal complex.
  • Magnetic resonance imaging (MRI) is excellent for evaluating soft tissue disease within the sinuses, but it is of little value in the diagnostic workup for acute sinusitis.

More on Sinusitis, Acute, Medical Treatment

Overview: Sinusitis, Acute, Medical Treatment
Differential Diagnoses & Workup: Sinusitis, Acute, Medical Treatment
Treatment & Medication: Sinusitis, Acute, Medical Treatment
Follow-up: Sinusitis, Acute, Medical Treatment
Multimedia: Sinusitis, Acute, Medical Treatment
References
Further Reading
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References

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  3. [Guideline] Rosenfeld RM, Andes D, Bhattacharyya N, Cheung D, Eisenberg S, Ganiats TG, et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg. Sep 2007;137(3 Suppl):S1-31. [Medline].

  4. Savolainen S, Jousimies-Somer H, Karjalainen J. Do simple laboratory tests help in etiologic diagnosis in acute maxillary sinusitis?. Acta Otolaryngol Suppl. 1997;529:144-7. [Medline].

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  12. Eibling DE. Maxillary Sinus: Irrigation Techniques. In: Myers EN, ed. Operative Otolaryngology-Head and Neck Surgery. Philadelphia, Pa: WB Saunders; 1997:81-85.

  13. Frenkiel S. Embryology of the Nose and Sinuses. In: Tewfik TL, Der Kaloustian VM, eds. Congenital Anomalies of the Ear, Nose, and Throat. New York: Oxford University Press; 1997:183-187.

  14. Graney DO, Rice DH. Anatomy. In: Cummings CW, Frederickson JM, Harker LA, Krause CJ, Richardson MA, Schuller DE, eds. Otolaryngology-Head & Neck Surgery. 3rd ed. St. Louis: Mosby; 1998:1059-1064.

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  23. Poole MD. A focus on acute sinusitis in adults: changes in disease management. Am J Med. May 3 1999;106(5A):38S-47S; discussion 48S-52S. [Medline].

  24. Rhys-Evans PH. Anatomy of the Nose and Paranasal Sinuses. In: Kerr AG, Groves J, eds. Scott-Brown's Otolaryngology. 5th ed. London: Butterworths; 1987:138-161.

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Further Reading

Clinical guidelines

Slavin RG, Spector SL, Bernstein IL, Kaliner MA, Kennedy DW, Virant FS, Wald ER, Khan DA, Blessing-Moore J, Lang DM, Nicklas RA, Oppenheimer JJ, Portnoy JM, Schuller DE, Tilles SA, Borish L, Nathan RA, Smart BA, Vandewalker ML, American Academy of Allergy, Asthma and Immunology, American College of Allergy, Asthma and Immunology, Joint Council of Allergy, Asthma and Immunology. The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol 2005 Dec;116(6 Suppl):S13-S47. 8

Rosenfeld RM, Andes D, Bhattacharyya N, Cheung D, Eisenberg S, Ganiats TG, Gelzer A, Hamilos D, Haydon RC 3rd, Hudgins PA, Jones S, Krouse HJ, Lee LH, Mahoney MC, Marple BF, Mitchell CJ, Nathan R, Shiffman RN, Smith TL, Witsell DL. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg 2007 Sep;137(3 Suppl):S1-31. 3

University of Michigan Health System. Acute rhinosinusitis in adults. Ann Arbor (MI): University of Michigan Health System; 2007 Mar. 8 p.

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Keywords

medical treatment for acute sinusitis, sinus infection, cold, runny nose, sinus headache, acute sinusitis, infection of the sinuses, recurrent acute sinusitis, subacute sinusitis, paranasal sinuses

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Contributor Information and Disclosures

Author

Steven E Sobol, MD, FRCSC, MSc, FAAP, Assistant Professor, Director of Pediatric Otolaryngology, Department of Otolaryngology Head and Neck Surgery, Emory University School of Medicine; Otolaryngologist-In-Chief, Children's Healthcare of Atlanta at Egleston
Steven E Sobol, MD, FRCSC, MSc, FAAP is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Melvin D Schloss, MD, FRCSC, Director of Pediatric Otolaryngology, Professor, Department of Otolaryngology, McGill University, Canada
Melvin D Schloss, MD, FRCSC is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Ted L Tewfik, MD, FRCS(C), Professor, Department of Otolaryngology, Director of Continuing Medical Education of Otolaryngology, McGill University Medical School; Director, Director of Professional Affairs of Otolaryngology, Department of Otolaryngology, Montreal Children's Hospital; Senior Staff, Montreal General Hospital and Royal Victoria Hospital
Ted L Tewfik, MD, FRCS(C) is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Society of Pediatric Otolaryngology, Canadian Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

Jack A Coleman, MD, Consulting Staff, Franklin Surgical Associates
Jack A Coleman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Sleep Medicine, American Bronchoesophagological Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Society for Laser Medicine and Surgery, and Association of Military Surgeons of the US
Disclosure: accarent, inc Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Stephen G Batuello, MD, Consulting Staff, Colorado ENT Specialists
Stephen G Batuello, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American Medical Association, and Colorado Medical Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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