Investigations
In primary care, acute rhinosinusitis (ARS) is a clinical diagnosis based on history and clinical features (1). There is no role for imaging or detailed ENT examinations for suspected ARS in primary care (2).
Anterior rhinoscopy (with an otoscope or Thudichum’s nasal speculum with headlight, depending on availability) can be carried out in primary care setting as part of the clinical assessment of suspected ARS. It may reveal supportive findings such as
- nasal inflammation
- mucosal oedema
- purulent nasal discharge
- previously unsuspected findings such as polyps or anatomical abnormalities (1).
CT may be considered in very severe disease, in immuno-compromised patients, or when there is a suspicion of possible complications (3)
Notes:
- CT
- CT of the paranasal sinuses provides valuable information but this should be interpreted in the context of the history and examination as the prevalence of incidental mucosal changes in an asymptomatic population is approximately 30%
MRI with and without intravenous contrast may be useful if extra-sinus complications are suspected (3)
Reference:
- Fokkens WJ et al.European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinol Suppl. 2012;23:3 p
- Ebell MH, McKay B, Guilbault R, et al. Diagnosis of acute rhinosinusitis in primary care: a systematic review of test accuracy. Br J Gen Pract. 2016 Aug 1;66(650):e612-32.
- American College of Radiology. ACR appropriateness criteria: sinonasal disease. 2021 [internet publication].
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