Skip to main content
Log in

The utility of radiologic studies in the diagnosis and management of rhinosinusitis

  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

The past two decades have seen the development of computed tomography scanning as the principal investigation for paranasal sinus disease. This article describes the benefits and limitations of computed tomography scanning in the assessment of rhinosinusitis. It also discusses the role of magnetic resonance imaging as a further diagnostic tool in the assessment of rhinosinusitis and in particular its complications. Other imaging modalities such as plain radiographs and ultrasound have limited use in this field. The introduction of image guidance techniques as an aid to surgical treatment and possible future developments are outlined.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Hughes R, Jones NS: The role of endoscopy in outpatient management. Clin Otolaryngol 1998, 23:224–226.

    Article  PubMed  CAS  Google Scholar 

  2. Lazar RH, Younis RT, Parvey LS: Comparison of plain radiographs, coronal CT, and intraoperative findings in children with chronic sinusitis. Otolaryngol Head Neck Surg 1992, 107:29–34.

    PubMed  CAS  Google Scholar 

  3. Ide C, Trigaux JP, Eloy P: Chronic sinusitis: the role of imaging. Acta Oto Rhino Laryngol Belg 1997, 51:247–258.

    CAS  Google Scholar 

  4. Cotter CS, Stringer S, Rust KR, Mancuso A: The role of computed tomography scans in evaluating sinus disease in pediatric patients. Int J Pediatr Otorhinolaryngol 1999, 50:63–68.

    Article  PubMed  CAS  Google Scholar 

  5. Konen E, Faibel M, Kleinbaum Y, et al.: The value of the occipitomental (Waters’) view in diagnosis of sinusitis: a comparative study with computed tomography. Clin Radiol 2000, 55:856–860.

    Article  PubMed  CAS  Google Scholar 

  6. Puhakka T, Heikkinen T, Makela MJ et al.: Validity of ultrasonography in diagnosis of acute maxillary sinusitis. Arch Otolaryngol Head Neck Surg 2000, 126:1482–1486.

    PubMed  CAS  Google Scholar 

  7. Royal College of Radiologists Working Party: Making the Best Use of a Department of Clinical Radiology: Guidelines for Doctors, edn 3. London: The Royal College of Radiologists; 1995.

    Google Scholar 

  8. Mason JD, Jones NS, Hughes RJ, Holland IM: A systematic approach to the interpretation of computed tomography scans prior to endoscopic sinus surgery. J Laryngol Otol 1998, 112:986–990.

    PubMed  CAS  Google Scholar 

  9. Hahnel S, Ertl-Wagner B, Tasman AJ, et al.: Relative value of MR imaging as compared with CT in the diagnosis of inflammatory paranasal sinus disease. Radiology 1999, 210:171–176.

    PubMed  CAS  Google Scholar 

  10. Salib RJ, Chaudri SA, Rockley TJ: Sinusitis in the hypoplastic maxillary antrum: the crucial role of radiology in diagnosis and management. J Laryngol Otol 2001, 115:676–678.

    Article  PubMed  CAS  Google Scholar 

  11. Jones NS, Strobl A, Holland I: A study of the CT findings in 100 patients with rhinosinusitis and 100 controls. Clin Otolaryngol Allied Sci 1997, 22:47–51.

    Article  PubMed  CAS  Google Scholar 

  12. Bhattacharyya N: Test-retest reliability of computed tomography in the assessment of chronic rhinosinusitis. Laryngoscope 1999, 109:1055–1058.

    Article  PubMed  CAS  Google Scholar 

  13. Diament MJ: The diagnosis of sinusitis in infants and children: x-ray, computed tomography, and magnetic resonance imaging. Diagnostic imaging of pediatric sinusitis. JAllergy Clin Immunol 1992, 90:442–444.

    Article  CAS  Google Scholar 

  14. Younis RT, Anand VK, Davidson B: The role of computed tomography and magnetic resonance imaging in patients with sinusitis with complications. Laryngoscope 2002, 112:224–229. This paper found that MRI is more accurate than CT at detecting meningitis or intracranial abscess.

    Article  PubMed  Google Scholar 

  15. Howells RC, Ramadan HH: Usefulness of computed tomography and magnetic resonance in fulminant invasive fungal rhinosinusitis. Am J Rhinol 2001, 15:255–261.

    PubMed  CAS  Google Scholar 

  16. Uzcategui N, Warman R, Smith A, Howard CW: Clinical practice guidelines for the management of orbital cellulites. J Paediatr Opthalmol Stabismus 1998, 35:73–79.

    CAS  Google Scholar 

  17. Jones NS, Walker JL, Bassi S, et al.: The intracranial complications of rhinosinusitis: can they be prevented? Laryngoscope 2002, 112:59–63.

    Article  PubMed  CAS  Google Scholar 

  18. Dahniya MH, Makkar R, Grexa E, et al.: Appearances of paranasal fungal sinusitis on computed tomography. Br J Radiol 1998, 71:340–344.

    PubMed  CAS  Google Scholar 

  19. Stammberger H, Jaske R, Beaufort F: Aspergillosis of the paranasal sinuses. X-ray diagnosis, histopathology and clinical aspects. Ann Oto Rhinol Laryngol 1984, 93:251–256.

    CAS  Google Scholar 

  20. Kennedy DW: Prognostic factors, outcomes and staging in ethmoid sinus surgery. Laryngoscope 1992, 102:1–18.

    PubMed  CAS  Google Scholar 

  21. Friedman WH, Katsantonis GP, Sivore M, Kay S: Computed tomography staging in of the paranasal sinuses in chronic hyper-plastic rhinosinusitis. Larungoscope 1990, 100:1161–1165.

    CAS  Google Scholar 

  22. Levine H, May M: Rhinology and Sinusology. New York: Thieme Medical Publishers; 1993.

    Google Scholar 

  23. Gliklich RE, Metson R: A comparison of sinus computed tomography (CT) staging systems for outcomes research. Am J Rhinol 1994, 8:291–297.

    Google Scholar 

  24. Lund VJ, Mackay IS: Staging in rhinosinusitis. Rhinology 1993, 31:183–184.

    PubMed  CAS  Google Scholar 

  25. Lund VJ, Kennedy DW: Staging for rhinosinusitis. Otolaryngol Head Neck Surg 1997, 3:S35-S40.

    Article  Google Scholar 

  26. Oluwole M, Russell N, Tan L, et al.: A comparison of computerized tomographic staging systems in chronic sinusitis. Clin Otolaryngol Allied Sci 1996, 21:91–95.

    PubMed  CAS  Google Scholar 

  27. Metson R, Gliklich RE, Stankiewicz JA, et al.: Comparison of sinus computed tomography staging systems. Otolaryngol Head Neck Surg 1997, 117:372–379.

    Article  PubMed  CAS  Google Scholar 

  28. Jones NS: CT of the paranasal sinuses: a review of the correlation with clinical, surgical and histopathological findings. Clin Otolaryngol 2002, 27:11–17. There is no consistent difference in the prevalence of anatomic variations between a symptomatic group and a control group, with the possible exception of a septal deviation where the evidence is less clear.

    Article  PubMed  CAS  Google Scholar 

  29. Lang J: Clinical Anatomy of the Nose, Nasal Cavity and Paranasal Sinuses. Stuttgart: George Thieme Verlag; 1989.

    Google Scholar 

  30. Kennedy DW, Zinreich SJ: Functional endoscopic approach to inflammatory sinus disease: current perspectives and technique modifications. Am J Rhinol 1988, 2:89–96.

    Google Scholar 

  31. Basic N, Basic V, Jukic T, et al.: Computed tomographic imaging to determine the frequency of anatomic variations in pneumatization of the ethmoid bone. Eur Arch Otolaryngol 1999, 256:69–71.

    CAS  Google Scholar 

  32. Arslan H, Aydinhoglu A, Bozkurt M, Egeli E: Anatomic variations of the paranasal sinuses: CT examination for endoscopic sinus surgery. Auris Nasus Larynx 1999, 26:39–48.

    Article  PubMed  CAS  Google Scholar 

  33. Danese M, Duvoisin B, Agrifoglio A, et al.: Influence of sinonasal variants on recurrent sinusitis of 112 patients. J Radiol 1997, 78:651–657.

    PubMed  CAS  Google Scholar 

  34. Perez-Pinas I, Sabate J, Camona A, et al.: Anatomical variations in the human paranasal sinus region studied by CT. J Anatomy 2000, 197:221–227.

    Article  Google Scholar 

  35. Lloyd GA: CT of the paranasal sinuses: study of a control series in relation to endoscopic sinus surgery. J Laryngol Otol 1990, 104:477–481.

    PubMed  CAS  Google Scholar 

  36. Lloyd GAS, Lund VJ, Scadding GK: CT of the paranasal sinuses and functional endoscopic sinus surgery: a critical analysis of 100 asymptomatic patient. J Laryngol Otol 1991, 105:181–185.

    PubMed  CAS  Google Scholar 

  37. Clark ST, Babin RW, Salazar J: The incidence of concha bullosa and its relationship to chronic sinonasal disease. Am J Rhinol 1989, 3:11–12.

    Google Scholar 

  38. Bolger WE, Butzin CA, Parsons DS: Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope 1991, 101:56–64.

    Article  PubMed  CAS  Google Scholar 

  39. Calhoun KH, Waggenspack GA, Simpson CB, et al.: CT evaluation of the paranasal sinuses in symptomatic and asymptomatic populations. Otolaryngol Head Neck Surg 1991, 104:480–483.

    PubMed  CAS  Google Scholar 

  40. Willner A, Choi SS, Vezina LG, Lozar RH: Intranasal anatomic variations in pediatric rhinosinusitis. Am J Rhinology 1997, 11:355–360.

    CAS  Google Scholar 

  41. Tonai A, Bala S: Anatomic variations of the bone in sinonasal CT. Acta Otolaryngol (Stockh) 1996, 525:9–13.

    CAS  Google Scholar 

  42. Kayalioglu G, Oyar O, Govsa F: Nasal cavity and paranasal sinus bony variations: a computed tomographic study. Rhinology 2000, 38:108–113.

    PubMed  CAS  Google Scholar 

  43. Medina J, Tom LWC, Marsh RR, Bilaniuk LT: Development of the paranasal sinuses in children with sinus disease. Am J Rhinol 1999, 13:23–26.

    PubMed  CAS  Google Scholar 

  44. Sonkens JW, Harnsberger HR, Blanch GM, et al.: The impact of screening sinus CT on the planning of functional endoscopic sinus surgery. Otolaryngol Head Neck Surg 1991, 105:802–813.

    PubMed  CAS  Google Scholar 

  45. Havas TE, Motbey JA, Gullane PJ: Prevalence of incidental abnormalities on computorised tomographic scans of the paranasal sinuses. Arch Otolaryngol Head Neck Surg 1988, 114:856–859.

    PubMed  CAS  Google Scholar 

  46. Shapiro GG, Rachelefsky GS: Introduction and definition of sinusitis. J Allergy Clin Immunol 1992, 90:417–418.

    Article  PubMed  CAS  Google Scholar 

  47. Gwaltney JM, Phillis CD, Miller RD, Riker DK: Computed tomographic study of the common cold. N Engl J Med 1994, 330:25–30.

    Article  PubMed  Google Scholar 

  48. Lesserson JA, Kieserman SP, Finn DG: The radiographic incidence of chronic sinus disease in the pediatric population. Laryngoscope 1994, 104:159–166.

    PubMed  CAS  Google Scholar 

  49. Manning S, Biavati MJ, Phillips, DL: Correlation of clinical sinusitis signs and symptoms to imaging findings in pediatric patients. Int J Pediatr Otorhinolaryngol 1996, 37:65–74.

    Article  PubMed  CAS  Google Scholar 

  50. Glasier CM, Mallory GB, Steele RW: Significance of opacification of the maxillary and ethmoid sinuses in infants. J Pediatr 1989, 114:45–50.

    Article  PubMed  CAS  Google Scholar 

  51. Jones NS: Current concepts in the management of paediatric rhinosinusitis. J Laryngol Otol 1999, 113:1–9.

    PubMed  CAS  Google Scholar 

  52. Van Der Veken PJ, Clement PA, Buisseret T, et al.: CT scan study of the incidence of sinus involvement and nasal anatomic variations in 196 children. Rhinology 1990, 28:177–184.

    PubMed  Google Scholar 

  53. Garcia DP, Corbett ML, Eberly SM, et al.: Radiographic imaging studies in pediatric chronic sinusitis. J Allergy Clin Immunol 1994, 94:523–530.

    Article  PubMed  CAS  Google Scholar 

  54. Gordts F, Clement PA, Destryker A, et al.: Prevalence of sinusitis signs on MRI in a non-ENT paediatric population. Rhinology 1997, 35:154–157.

    PubMed  CAS  Google Scholar 

  55. Tarp B, Fiirgaard B, Christensen T, et al.: The prevalence and significance of incidental paranasal sinus abnormalities on MRI. Rhinology 2000, 38:33–38.

    PubMed  CAS  Google Scholar 

  56. West B, Jones NS: Endoscopy negative, CT negative facial pain in a nasal clinic. Laryngoscope 2001, 111:581–586.

    Article  PubMed  CAS  Google Scholar 

  57. Cook PR, Nishioka GJ, Davis WE, McKinsey JP: Functional endoscopic sinus surgery in patients with normal computed tomography scans. Otolaryngol Head Neck Surg 1994, 110:505–509.

    PubMed  CAS  Google Scholar 

  58. Sessle BJ: Acute and chronic craniofacial pain: brainstem mechanisms of nocioceptive transmission and neuroplasticity, and other clinical correlates. Crit Rev Oral Biol Med 2000, 11:57–91.

    Article  PubMed  CAS  Google Scholar 

  59. Graff-Radford SB: Facial pain. Curr Opin Neurol 2000, 13:291–296.

    Article  PubMed  CAS  Google Scholar 

  60. Bhattacharyya T, Piccirillo J, Wippold FJ: Relationship between patient-based descriptions of sinusitis and paranasal sinus computed tomographic findings. Arch Otolaryngol Head Neck Surg 1997, 123:1189–1192.

    PubMed  CAS  Google Scholar 

  61. Stewart MG, Sicard MW, Piccirillo JF, et al.: Severity staging in chronic sinusitis: are CT scan findings related to patient symptoms? Am J Rhinol 1999, 13:161–167.

    PubMed  CAS  Google Scholar 

  62. Arango P, Kountakis SE: Significance of computed tomography pathology in chronic rhinosinusitis. Laryngoscope 2001, 111:1779–1782.

    Article  PubMed  CAS  Google Scholar 

  63. Krouse JH: Computed tomography stage, allergy testing, and quality of life in patients with sinusitis. Otolaryngol Head Neck Surg 2000, 123:389–392.

    Article  PubMed  CAS  Google Scholar 

  64. Jianetto DF, Pratt MF: Correlation between preoperative computed tomography and operative findings in functional endoscopic sinus surgery. Laryngoscope 1995, 105:924–927.

    Article  Google Scholar 

  65. Fisher EW, Whittet HB, Croft CB: Symptomatic mucosal cysts of the maxillary sinus: antroscopic treatment. J Laryngol Otol 1989, 103:1184–1186.

    PubMed  CAS  Google Scholar 

  66. Bhattacharyya N: Do maxillary retention cysts reflect obstructive sinus phenomena? Arch Otolaryngol Head Neck Surg 2000, 126:1369–1371.

    PubMed  CAS  Google Scholar 

  67. Ruprecht A, Batniji S, el-Newiehi E: Mucous retention cyst of the maxillary sinus. Oral Surg Oral Med Oral Pathol 1986, 62:728–731.

    Article  PubMed  CAS  Google Scholar 

  68. Moser FG, Panush D, Rubin JS, et al.: Incidental paranasal sinus abnormalities on MRI of the brain. Clin Radiol 1991, 43:252–254.

    Article  PubMed  CAS  Google Scholar 

  69. Maresh MM, Washburn AH: Paranasal sinuses from birth to late adolescence: clinical and roentographic evidence of infection. Am J Dis Child 1940, 60:841–861.

    Google Scholar 

  70. Fascenelli FW: Maxillary sinus abnormalities: radiographic evidence in an aymptomatic population. Arch Otolaryngol Head Neck Surg 1969, 90:98–101.

    Google Scholar 

  71. Shopfiner CE, Rossi JO: Roentogen evaluation of the paranasal sinuses in a child. Am J Roentgenol 1973, 118:176–186.

    Google Scholar 

  72. Kovatch AL, Wald ER, Ledesma-Medina J, et al.: Maxillary sinus radiographs in children with non-respiratory complaints. Pediatrics 1984, 73:306–308.

    PubMed  CAS  Google Scholar 

  73. Diament MJ, Senac MO, Gilsanz V: Prevalence of incidental paranasal sinus opacification in pediatric patients: a CT study. J Comput Assist Tomogr 1987, 11:426–431.

    Article  PubMed  CAS  Google Scholar 

  74. McAllister WH, Lusk R, Muntz HR: Comparison of plain radiographs and coronal CT scans in infants and children with recurrent sinusitis. Am J Roentgenol 1989, 153:1259–1264.

    Google Scholar 

  75. Wald ER: Radiographic sinusitis: illusion or delusion? Pediatr Infect Dis J 1993, 12:792–793.

    Article  PubMed  CAS  Google Scholar 

  76. Fried MP, Topulos G, Hsu L, et al.: Endoscopic sinus surgery with magnetic resonance imaging guidance: initial patient experience. Otolaryngol Head Neck Surg 1998, 119:374–380.

    Article  PubMed  CAS  Google Scholar 

  77. Cartellieri M, Vorbeck F: Endoscopic sinus surgery using intraoperative computed tomography imaging for updating a three-dimensional navigation system. Laryngoscope 2000, 110:292–296. The disadvantages of endoscopic sinus surgery in a CT scanner with intraoperative updated images (exposure to radiation, prolonged anesthesia, and cost) outweighed the advantages (recognition of intraoperative changes and higher accuracy of the navigation system), and this technique is not recommended for current clinical practice.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Marshall, A.H., Jones, N.S. The utility of radiologic studies in the diagnosis and management of rhinosinusitis. Curr Infect Dis Rep 5, 199–204 (2003). https://doi.org/10.1007/s11908-003-0074-y

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11908-003-0074-y

Keywords

Navigation