Limited axial CT of the paranasal sinuses in screening for sinusitis.

Abstract

E valuation of sinusitis. which affects 50 million people in the United States, is a major contributor to health care expenditures. Although empiric antibiotic treatment of all patients with symptoms of sinusitis is controversial I I j, most treated patients respond to initial antibiotic therapy. Radiographic documentation of sinus disease is desirable in certain patients. especially to determine the need for more comprehensive and protracted antibiotic regimens (with additional office visits) in patients whose symptoms persist after mitial therapy. Radiographic distinction of sinusitis from rhinitis can be useful in patients predisposed to rhinitis. because both can have identical clinical pictures. Such patients include smokers or those with allergies or a history of occupational exposure. Radiographic identification of isolated nasal disease (i.e., swollen turbinates) is important because rhinitis is usually treated symptomatically or with lifestyle changes. CT scans have been shown to be superior to standard sinus radiographs in evaluating recurrent sinusitis, particularly ethmoid and sphenoid sinusitis in children 12-4]. The use of sinus CT has focused mainly on coronal screening studies before functional endoscopic sinonasal surgery. Coronal CT requires prone positioning for prolonged periods ( I 520 mm) of time while 20 or more slices are obtained through the paranasal sinuses. A reliable, more comfortable, and less expensive screening examination to replace plain films is desirable in these patients.