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

Sinusitis, Frontal, Acute, Surgical Treatment: Workup

Author: Priya Krishna, MD, Assistant Professor, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine
Coauthor(s): Dennis Lee, MD, MPH, Director, Assistant Professor, Department of Otolaryngology, Division of Pediatric Otolaryngology, Southern Illinois University School of Medicine
Contributor Information and Disclosures

Updated: Feb 6, 2008

Workup

Laboratory Studies

  • The diagnosis of acute frontal sinusitis mainly rests on the features of the history and physical examination, as described above (see Clinical).
  • A white blood cell count with examination of the neutrophil count may indicate an acute inflammatory or infectious process, but it is nonspecific.
  • The role of culture is not well defined. At best, its findings are also nonspecific because most bacterial isolates are Streptococcus pneumoniae and H influenzae.

Imaging Studies

  • The role of imaging in acute frontal sinusitis is to establish its extent and help depict any orbital or intracranial complications. Conventional radiography, consisting of the acquisition of Caldwell, Waters, lateral, and submentovertex views, is mainly of historical interest because of the current widespread availability of more sophisticated imaging modalities (ie, CT scanning and MRI).
  • CT scanning is the imaging study of choice because it depicts optimal bony, soft tissue, and air detail in the setting of sinus disease. Coronal and axial paranasal CT images can be diagnostic and aid in preoperative preparation. Intravenous contrast enhancement should be considered if abscess formation is suspected.
    • Three-millimeter nonenhanced coronal sections are recommended for the following reasons: They best correlate with surgical approaches, they demonstrate the ostiomeatal complex and channels, and they accurately depict the relationship of the brain to the fovea ethmoidalis and ethmoid sinus and the relationship of the orbits to the sinuses.
    • CT scanning allows visualization of important anatomic variations such as the position of the ethmoid roof, which lies above the cribriform plate in more than two thirds of cases but below it in one third of cases.
    • Appropriate windows for soft tissue and air are chosen at a width of 2000 Hounsfield units (HU) with a level of -200 HU.
    • An air-fluid level is a typical finding in acute sinusitis in general, but it is not pathognomonic because blood can have the same appearance. The air-fluid level has intermediate attenuation on CT scans when it is acute.
    • Other findings may include complete opacification of the sinus or smooth or nodular mucosal thickening.
  • MRI provides excellent soft tissue detail but less air and bony detail. Since acute sinusitis is a disease of the air passages, MRI is not the initial imaging study of choice. MRI is very sensitive in providing sinus mucosal definition, however. Acute inflammation and infection have high signal intensity on T2-weighted images. MRI has been used to follow the frontal sinus after obliteration.

More on Sinusitis, Frontal, Acute, Surgical Treatment

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Workup: Sinusitis, Frontal, Acute, Surgical Treatment
Treatment: Sinusitis, Frontal, Acute, Surgical Treatment
Follow-up: Sinusitis, Frontal, Acute, Surgical Treatment
Multimedia: Sinusitis, Frontal, Acute, Surgical Treatment
References
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Further Reading

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Keywords

sinus infection, acute sinusitis, bacterial sinusitis, chronic sinusitis, acute frontal sinusitis, upper respiratory infection, sinusitis, ethmoid sinus, frontal sinus, nasal polyps, nasal tumor, septal deviation, nasal trauma, mucosal swelling, mucociliary clearance, rhinorrhea, sinus headache, Haemophilus influenzae, Streptococcus species, Moraxella catarrhalis, meningitis, brain abscess, epidural empyema, subdural empyema, cerebral empyema, preseptal cellulitis, orbital cellulitis, subperiosteal abscess, cavernous sinus thrombosis, Pott puffy tumor, sinocutaneous fistula, osteomyelitis, trephination, frontoethmoidectomy, endoscopic sinus surgery, mucoceles, pyoceles, Lynch approach, Killian method, Reidel method, cranioplasty, Lothrop technique, Chaput-Meyer technique, osteoplastic flap, obliteration of the frontal sinus, nasal endoscopy, functional endoscopic sinus surgery, sinus surgery

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Contributor Information and Disclosures

Author

Priya Krishna, MD, Assistant Professor, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine
Priya Krishna, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and Voice Foundation
Disclosure: Nothing to disclose.

Coauthor(s)

Dennis Lee, MD, MPH, Director, Assistant Professor, Department of Otolaryngology, Division of Pediatric Otolaryngology, Southern Illinois University School of Medicine
Dennis Lee, MD, MPH 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 Laryngological Rhinological and Otological Society, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Eric J Moore, MD, FACS, Residency Director, Assistant Professor, Department of Otorhinolaryngology/Head and Neck Surgery, Mayo Graduate School of Medicine
Eric J Moore, MD, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, and American Rhinologic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Erik Kass, MD, Chief, Department of Clinical Otolaryngology, Associates in Otolaryngology of Northern Virginia
Erik Kass, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Association for Cancer Research, American Medical Association, and American Rhinologic 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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