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

Sinusitis, Ethmoid, Acute, Surgical Treatment: Workup

Author: Michael Mercandetti, MD, MBA, FACS, Consulting Staff, Department of Surgery, Doctors Hospital of Sarasota
Coauthor(s): Adam J Cohen, MD, Eyelid and Facial Aesthetic and Reconstructive Surgery, Diseases and Surgery of the Orbit and Lacrimal System, Cosmetic Laser Surgery; Joseph P Mirante, MD, MBA, FACS, Clinical Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of South Florida College of Medicine
Contributor Information and Disclosures

Updated: Aug 28, 2009

Workup

Laboratory Studies

  • As in all medical maladies, a thorough history and physical examination are required.
  • Laboratory studies can include assessment for an elevated WBC count. However, this would be most useful for those patients with systemic findings.
  • Cultures of the nasal passages may be helpful if culturable material is present. However, the pathogens found on the nasal mucosa may not be representative of the pathogens within the sinus.

Imaging Studies

  • In the past, radiographs using both the Caldwell view to evaluate the ethmoid and frontal sinuses and the Waters view to evaluate the maxillary sinuses for concomitant involvement were often obtained in the evaluation of patients with acute ethmoid sinusitis.
  • Computerized tomography (CT) of the paranasal sinuses and nose is the preferred method for imaging these structures because of its superior detail and clarity.

Diagnostic Procedures

  • Nasal examination with a speculum is warranted to assess the intranasal structures. However, nasal endoscopy provides more detailed information and a more thorough examination than a nasal speculum examination.
  • The typical nasal endoscopic examination is done in 3 passes, usually using a 0 º  endoscope. Other endoscopes, such as 30 º or 70 º degree endoscopes, can also be used.
    • The first pass assesses the floor of the nasal cavity, the inferior turbinate, the septum, the inferior meatus, the eustachian orifice, the nasolacrimal duct opening, and the nasopharynx.
    • The second pass is directed toward the middle meatus between the middle and the inferior turbinate. This part of the examination evaluates the middle meatus, middle turbinate, uncinate process, bulla ethmoidalis, hiatus semilunaris, and the ostium of the maxillary sinus.
    • The third pass is accomplished by passing the endoscope upward directed toward the roof of the nasal cavity, between the upper part of the middle turbinate and the nasal septum, examining the frontal recess, the sphenoethmoidal recess, and ostium of the sphenoid sinus.
    • The condition of the nasal mucosa, discharge, anatomy, and other causes of obstruction such as abnormal turbinates, polyps, tumors, or foreign bodies can be searched for.5,10
    • Cultures can also be obtained.

More on Sinusitis, Ethmoid, Acute, Surgical Treatment

Overview: Sinusitis, Ethmoid, Acute, Surgical Treatment
Workup: Sinusitis, Ethmoid, Acute, Surgical Treatment
Treatment: Sinusitis, Ethmoid, Acute, Surgical Treatment
Follow-up: Sinusitis, Ethmoid, Acute, Surgical Treatment
Multimedia: Sinusitis, Ethmoid, Acute, Surgical Treatment
References
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References

  1. Zukerlandl E. Normal und Pathologische Anatomie der Nasenhle und Iher Pneumatischen Anhänge. Wein Braümuller.

  2. Hirschmann A. Uber Endoskopie der Nase und deren Nebenholhen. Arch Otorhinolaryngol (Berlin). 1903;14:194-8.

  3. Jones N. Endoscopic sinus surgery. In: Jones AS, Phillips DE, Hilgers FJ, eds. Diseases of the Head and Neck, Nose and Throat. 1st ed. Arnold Edward;1998:846-867.

  4. [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].

  5. Feldman BA, Feldman DA. The nose and sinuses. In: Essential Otolaryngology: Head and Neck Surgery. 5th ed. Appleton & Lange;1991:669-81.

  6. Schuller DE, Schleuning AJ. Clinical problems. In: DeWeese and Saunder's Otolaryngology: Head and Neck Surgery. 8th ed. 1997:89-133.

  7. Wolf G, Anderhuber W, Kuhn F. Development of the paranasal sinuses in children: implications for paranasal sinus surgery. Ann Otol Rhinol Laryngol. Sep 1993;102(9):705-11. [Medline].

  8. Gardner E, Gray DJ, O'Rahilly RO. Nose and paranasal sinuses. In: Anatomy: A Regional Study of Human Structure. 4th ed. WB Saunders Co;1975:732-41.

  9. Swift AC. Complications of sinusitis. In: Jones AS, Phillips DE, Hilgers FJ, eds. Diseases of the Head and Neck, Nose and Throat. 1st ed. Arnold Edward;1998:868-83.

  10. Yanagisawa E. Endoscopic anatomy of the lateral nasal wall and the paranasal sinuses. In: Krouse JH, Christmas DA, eds. Powered Endoscopic Sinus Surgery. 1997:7-26.

  11. Lawson W. The intranasal ethmoidectomy: evolution and an assessment of the procedure. Laryngoscope. Jun 1994;104(6 Pt 2):1-49. [Medline].

  12. Miller RH, Cote DN. Open operation for paranasal sinusitis. In: Ballenger JJ, Snow JB Jr, eds. Otorhinolaryngology: Head and Neck Surgery. 15th ed. Lippincott Williams & Wilkins;1996:185-9.

  13. Templer J. Ethmoidectomy. In: English GH, ed. Otolaryngology. Vol 2. 1997:1-8.

  14. Aral M, Keles E, Kaygusuz I. The microbiology of ethmoid and maxillary sinuses in patients with chronicsinusitis. Am J Otolaryngol. May-Jun 2003;24(3):163-8. [Medline].

  15. Ben Simon GJ, Bush S, Selva D, McNab AA. Orbital cellulitis: a rare complication after orbital blowout fracture. Ophthalmology. Nov 2005;112(11):2030-4. [Medline].

  16. Brook I. Bacteriology of acute and chronic ethmoid sinusitis. J Clin Microbiol. Jul 2005;43(7):3479-80. [Medline].

  17. Hosemann W, Wigand ME, Nikol J. [Clinical and functional aspects of endonasal operation of the maxillary sinuses]. HNO. Jun 1989;37(6):225-30. [Medline].

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Further Reading

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Keywords

ethmoid sinusitis, ethmoid infection, ethmoiditis, ethmoidectomy, external ethmoidectomy, intranasal ethmoidectomy, endoscopic ethmoidectomy, transantral ethmoidectomy

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Contributor Information and Disclosures

Author

Michael Mercandetti, MD, MBA, FACS, Consulting Staff, Department of Surgery, Doctors Hospital of Sarasota
Michael Mercandetti, MD, MBA, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Ophthalmology, American College of Surgeons, American Society for Laser Medicine and Surgery, American Society of Ophthalmic Plastic and Reconstructive Surgery, Association of Military Surgeons of the US, and Sarasota County Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Adam J Cohen, MD, Eyelid and Facial Aesthetic and Reconstructive Surgery, Diseases and Surgery of the Orbit and Lacrimal System, Cosmetic Laser Surgery
Adam J Cohen, MD is a member of the following medical societies: American Academy of Ophthalmology and American College of Surgeons
Disclosure: Nothing to disclose.

Joseph P Mirante, MD, MBA, FACS, Clinical Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of South Florida College of Medicine
Disclosure: Nothing to disclose.

Medical Editor

Lanny Garth Close, MD, Chair, Professor, Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons
Lanny Garth Close, 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, American College of Physicians, American Laryngological Association, American Society for Head and Neck Surgery, and New York Academy of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Gregory C Allen, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Gregory C Allen, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, Christian Medical & Dental Society, 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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