Investigations
1st investigations to order
anterior rhinoscopy
Test
Performed as part of initial physical examination, both in primary care clinic and by specialist. Nasal speculum with light source or otoscope can be used.
Video outlining how to perform an examination of the nose and nasal cavity
Intranasal purulence, as well as posterior oropharyngeal purulence, can be seen.
Result
polyps, purulence from middle meatus, or structural abnormalities may be seen
nasal endoscopy
Test
Performed by an ear, nose, and throat physician in the clinic setting after nasal decongestion. No anaesthesia is needed as it is pain-free and generally well tolerated. A flexible or rigid telescope (endoscope) allows direct visualisation of entire nasal cavity and sinus outflow tracts.
Result
polyps, gross purulence, or structural obstruction may be seen
Investigations to consider
sinus CT
Test
CT scan without contrast confirms diagnosis. It should be ordered to confirm and stage chronic rhinosinusitis in patients who fail maximal medical management. Contrast can be helpful if there is concern about intracranial or intra-orbital suppurative complications. Axial and sagittal planar views are useful to evaluate anatomical relationships (e.g., frontal sinus disease) and for surgical planning.[23]
Result
opacification of involved sinuses, mucosal thickening, air-fluid levels, or anatomical abnormalities such as polyps, retention cysts, or sclerotic or thickened sinus walls
sinus MRI
Test
Adjunct to CT. Superior soft-tissue resolution, but does not visualise bony sinus partitions. Typically reserved for patients with suspected intracranial extension of inflammatory sinus disease, select cases of fungal disease, or neoplasia.[23][24]
Result
sinus opacification, mucosal thickening, air-fluid levels, anatomical abnormalities, or enhancement with gadolinium
nasal/sinus cultures
Test
Difficult to obtain and often contaminated if done via anterior rhinoscopy. Endoscopically guided cultures taken directly from secretions in the middle meatus by a specialist may provide information about pathogenic bacteria within the sinuses and help to guide antibiotic therapy.[25][26] Generally not necessary for the treatment of community-acquired infections unless a patient fails to respond to empirical therapy.
Result
presence of a pathogen
allergy testing
Test
Allergic rhinitis is a common predisposing factor. A variety of in vivo (scratch, intradermal testing) and in vitro (specific IgE determination) tests are available to evaluate suspected allergy. Scratch and intradermal tests will show oedema (wheal) and erythema (flare) if positive for specific allergens; in vitro-specific IgE determination may detect allergic response to a specific allergen.
Result
positive
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