Diagnostic evaluation for sinus pathology

Abstract

Paranasal sinusitis is the most common cause of a unilateral nasal discharge. External clinical signs such as nasal discharge and lymphadenopathy are common to both primary sinusitis and many causes of secondary sinusitis creating a diagnostic challenge. The complex anatomy coupled with relative inaccessibility precludes direct examination so a clinician must rely on carefully performed diagnostic tests. Upper respiratory endoscopy should be used to eliminate other causes of unilateral nasal discharge such as guttural pouch empyema. Detailed oral examination should be used to eliminate occlusal dental problems and radiography used to determine precise sinus involvement and apical dental pathology. Should these tests yield equivocal results, advanced head imaging such as computed tomography (CT) may provide a definitive diagnosis and further anatomical information. Direct sinus endoscopy through trephination can be both diagnostic for inspissated material, and therapeutic by allowing lavage to be performed.