Sinusitis (Sinus Infection) Diagnosis
Your doctor will ask many questions in order to get a complete medical history. They’ll also want to know your symptoms. A complete physical exam will be performed. During your exam, your healthcare provider examines your throat, nose, and ears for swelling, drainage, or blockage. A small, optical/lighted tool called an endoscope can be used to examine the inside of the nose. You may need to consult an ENT specialist in some cases. Your healthcare provider will perform a computed-tomography scan if you need an imaging exam. Most of the time, a sinus infection is diagnosed by the patient’s examination and medical history.
Most doctors do not have MRI or CT scans, which are more sensitive and can examine a sinusitis. These are expensive and are not readily available. Therefore, sinus infections are usually diagnosed and treated based upon the clinical findings of the checkup.
The physical findings may include:
- Swelling around the cheeks and eye
- Nasal swelling and redness
- The sinuses are sensitive to tapping on the forehead or cheeks.
- Purulent (push) drainage from the nasal passages.
In most cases, nasal secretions will be checked for cells that may help differentiate between allergic and infective sinusitis. The infection of the sinuses can be detected by polymorphonuclear (infection) cells, while an allergic infection may reveal white blood cells that are specific to allergy (eosinophils). If a bacterial infection is suspected, general physicians will recommend antibiotics. Most doctors treat the symptoms instead of using antibiotics, as they are ineffective against viral infections. If the sinus infection does not respond to the initial treatment, then detailed studies like MRI or CT scanning may be done.
It is possible to use ultrasound to diagnose sinusitis during pregnancy, but it’s not as accurate as MRI and CT. Sometimes it is necessary to perform a needle aspiration (needle puncture) to obtain infected material for culture. This will help determine the microbe that’s causing sinusitis. Nasal passage cultures are not very useful in determining what fungus, bacteria or virus is causing the sinusitis. This is because nasal passages can be colonized by bacteria that are not infectious.
An otolaryngologist will use the needle puncture technique when other treatments have failed. Local anesthesia is required to minimize any discomfort. Few patients require general anesthesia. The sinus is punctured and the contents are injected for staining, culture and removal of the sinus with saline. It is technically the most accurate way to test for infectious sinusitis. Fungal infections can be diagnosed using biopsy techniques and tissue removed for microscopic identification.
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