Acute Sinusitis in Adults and Children: Evidence-Based Emergency Imaging

  • Laura B. Eisenmenger
  • Yoshimi AnzaiEmail author
Part of the Evidence-Based Imaging book series (Evidence-Based Imag.)


Sinusitis is diagnosed and managed based on clinical grounds and imaging is not indicated for initial diagnosis of uncomplicated sinusitis. CT remains the primary imaging study of choice for patients with acute and chronic sinusitis. CT is indicated when patients do not respond to medical management as patients may have a structural abnormality or obstructive lesion. Imaging is also indicated in patients who are suspected of having sinusitis related to orbital and intracranial complications, to immunocompromised state, or for pre-operative surgical planning.


CT MR Sinus radiography Emergency imaging Acute sinusitis Chronic sinusitis Orbital and intracranial complications Immunocompromised state Surgery Evidence-based imaging 



Dr. Anzai would like to acknowledge the work of Dr. Angelisa Paladin, coauthor in a previous chapter on Diagnosis and Management of Acute and Chronic Sinusitis in Children in Medina LS, et al., eds: Evidence-Based Imaging in Pediatrics: Improving the Quality of Imaging in Patient Care, published by Springer Science in 2010. That chapter was drawn upon for this new chapter, in the process of presenting thoroughly updated and significantly revised coverage of this subject for emergency imaging.


  1. 1.
    Lanza DC, Kennedy DW. Otolaryngol Head Neck Surg. 1997;117(3 Pt 2):S1–7.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Kennedy DW. Otolaryngol Head Neck Surg. 1990;103(5 (Pt 2)):884–6.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Brook I. Proc Am Thorac Soc. 2011;8(1):90–100.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Fletcher MA, Fritzell B. Vaccine. 2007;25(13):2507–12.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Brook I. Int J Pediatr Otorhinolaryngol. 2007;71(11):1653–61.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Blackwell DL, Lucas JW, Clarke TC. Summary health statistics for U.S. adults: national health interview survey, 2012. Vital Health Stat Series 10, Data from the National Health Survey. 2014(260):1–161.Google Scholar
  7. 7.
    Shapiro DJ, Gonzales R, Cabana MD, et al. Pediatrics. 2011;127(1):28–34.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Senior BA, Kennedy DW, Tanabodee J, et al. Laryngoscope. 1998;108(2):151–7.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Ioannidis JP, Lau J. Pediatrics. 2001;108(3):E57.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Clement PA, Bluestone CD, Gordts F, et al. Int J Pediatr Otorhinolaryngol. 1999;49(Suppl 1):S95–100.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Garbutt JM, Goldstein M, Gellman E, et al. Pediatrics. 2001;107(4):619–25.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    American Academy of Pediatrics. Subcommittee on Management of S, Committee on Quality I. Pediatrics. 2001;108(3):798–808.Google Scholar
  13. 13.
    Wald ER, Applegate KE, Bordley C, et al. Pediatrics. 2013;132(1):e262–80.CrossRefGoogle Scholar
  14. 14.
    Collins JG. Prevalence of selected chronic conditions: United States, 1990–1992. Vital Health Stat Series 10, Data from the National Health Survey. 1997(194):1–89.Google Scholar
  15. 15.
    National Ambulatory Medical Care Survey: 2009 Summary Tables. 2009.Google Scholar
  16. 16.
    Bhattacharyya N. Ann Otol Rhinol Laryngol. 2011;120(7):423–7.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Ray NF, Baraniuk JN, Thamer M, et al. J Allergy Clin Immunol. 1999;103(3 Pt 1):408–14.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Smith SS, Kern RC, Chandra RK, et al. Otolaryngol Head Neck Surg. 2013;148(5):852–9.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Lau J, Zucker D, Engels EA, et al. Diagnosis and treatment of acute bacterial rhinosinusitis. Evid Rep Technol Assess. 1999(9):1–5. AHRQ Evidence Report Summaries.Google Scholar
  20. 20.
    Caulley L, Thavorn K, Rudmik L, et al. J Allergy Clin Immunol. 2015;136(6):1517–22.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Brooks I, Gooch WM 3rd, Jenkins SG, et al. Ann Otol Rhinol Laryngol Suppl. 2000;182:2–1920.Google Scholar
  22. 22.
    Smith SS, Evans CT, Tan BK, et al. J Allergy Clin Immunol. 2013;132(5):1230–2.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    McAlister WH, Parker BR, Kushner DC, et al. Radiology. 2000;215(Suppl):811–8.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Cornelius RS, Martin J, Wippold FJ 2nd, et al. J Am Coll Radiol. 2013;10(4):241–6.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Nash D, Wald E. Pediatr Rev. 2001;22(4):111–7.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Rosenfeld RM, Andes D, Bhattacharyya N, et al. Otolaryngol Head Neck Surg. 2007;137(3 Suppl):S1–31.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Otolaryngol Head Neck Surg. 2015;152(4):598–609.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Wald ER. Am J Med Sci. 1998;316(1):13–20.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Thanasumpun T, Batra PS. Am J Otolaryngol. 2015;36(5):686–91.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Reider JM, Nashelsky J, Neher J. J Fam Pract. 2003;52(7):565–7.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Kronemer KA, McAlister WH. Pediatr Radiol. 1997;27(11):837–46.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Howe L, Jones NS. Clin Otolaryngol Allied Sci. 2004;29(6):725–8.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Diament MJ. J Allergy Clin Immunol. 1992;90(3 Pt 2):442–4.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Dessi P, Champsaur P, Paris J, et al. Rev Laryngol Otol Rhinol. 1999;120(3):173–6.Google Scholar
  35. 35.
    Eufinger H, Machtens E. J Cranio-Maxillo-Facial Surg. 2001;29(2):111–7.CrossRefGoogle Scholar
  36. 36.
    Eustis HS, Mafee MF, Walton C, et al. Radiol Clin N Am. 1998;36(6):1165–83. xiCrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Mafee MF, Tran BH, Chapa AR. Clin Rev Allergy Immunol. 2006;30(3):165–86.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Wald ER, Chiponis D, Ledesma-Medina J. Pediatrics. 1986;77(6):795–800.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Gordts F, Halewyck S, Pierard D, et al. J Laryngol Otol. 2000;114(3):184–8.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Williams JW Jr, Simel DL, Roberts L, et al. Ann Intern Med. 1992;117(9):705–10.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Revonta M, Blokmanis A. Can Fam Physician. 1994;40:1969–72, 75–6.Google Scholar
  42. 42.
    van Buchem FL, Knottnerus JA, Schrijnemaekers VJ, et al. Lancet. 1997;349(9053):683–7.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Laine K, Maatta T, Varonen H, et al. Rhinology. 1998;36(1):2–6.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Engels EA, Terrin N, Barza M, et al. J Clin Epidemiol. 2000;53(8):852–62.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Varonen H, Makela M, Savolainen S, et al. J Clin Epidemiol. 2000;53(9):940–8.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Berg O, Carenfelt C. Acta Otolaryngol. 1988;105(3-4):343–9.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Berg O, Carenfelt C. Laryngoscope. 1985;95(7 Pt 1):851–3.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Savolainen S, Pietola M, Kiukaanniemi H, et al. Acta Otolaryngol Suppl. 1997;529:148–52.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Varonen H, Savolainen S, Kunnamo I, et al. Rhinology. 2003;41(1):37–43.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Som PM. Neuroradiology. 1985;27(3):189–201.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Aalokken TM, Hagtvedt T, Dalen I, et al. Dentomaxillofac Radiol. 2003;32(1):60–2.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Konen E, Faibel M, Kleinbaum Y, et al. Clin Radiol. 2000;55(11):856–60.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Mendes Neto JA, Guerreiro VM, Hirai ER, et al. Braz J Otorhinolaryngol. 2012;78(4):35–41.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Glasier CM, Ascher DP, Williams KD. AJNR Am J Neuroradiol. 1986;7(5):861–4.PubMedPubMedCentralGoogle Scholar
  55. 55.
    Gwaltney JM Jr, Phillips CD, Miller RD, et al. N Engl J Med. 1994;330(1):25–30.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Berg O, Bergstedt H, Carenfelt C, et al. Ann Otol Rhinol Laryngol. 1981;90(3 Pt 1):272–5.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    April MM, Zinreich SJ, Baroody FM, et al. Laryngoscope. 1993;103(9):985–90.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Vazquez E, Creixell S, Carreno JC, et al. Curr Probl Diagn Radiol. 2004;33(3):127–45.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Kennedy DW, Senior BA. Otolaryngol Clin N Am. 1997;30(3):313–30.Google Scholar
  60. 60.
    Jiannetto DF, Pratt MF. Laryngoscope. 1995;105(9 Pt 1):924–7.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Otolaryngol Head Neck Surg. 2015;152(2 Suppl):S1–S39.Google Scholar
  62. 62.
    Ali A, Kurien M, Mathews SS, et al. Singap Med J. 2005;46(10):540–4.Google Scholar
  63. 63.
    Thompson AM, Couch M, Zahurak ML, et al. Bone Marrow Transplant. 2002;29(3):257–61.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Grundmann T, Weerda H. Laryngorhinootologie. 1997;76(9):534–9.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Larson TL. Semin Ultrasound CT MR. 1999;20(6):379–90.CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Clary RA, Cunningham MJ, Eavey RD. Ann Otol Rhinol Laryngol. 1992;101(7):598–600.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Reid JR. Pediatr Radiol. 2004;34(12):933–42.CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    Unlu HH, Aslan A, Goktan C, et al. Auris Nasus Larynx. 2002;29(1):69–71.CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Nawashiro H, Shimizu A, Shima K, et al. Neurol Med Chir. 1996;36(11):808–11.CrossRefGoogle Scholar
  70. 70.
    Rochat P, von Buchwald C, Wagner A. Rhinology. 2001;39(3):173–5.PubMedPubMedCentralGoogle Scholar
  71. 71.
    Fountas KN, Duwayri Y, Kapsalaki E, et al. South Med J 2004;97(3):279–82; quiz 83.Google Scholar
  72. 72.
    Younis RT, Anand VK, Davidson B. Laryngoscope. 2002;112(2):224–9.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Franzese CB, Stringer SP. Am J Rhinol. 2004;18(5):329–34.CrossRefPubMedPubMedCentralGoogle Scholar
  74. 74.
    Bolger WE, Butzin CA, Parsons DS. Laryngoscope. 1991;101(1 Pt 1):56–64.PubMedPubMedCentralGoogle Scholar
  75. 75.
    von Kalle T, Fabig-Moritz C, Heumann H, et al. RoFo. 2012;184(7):629–34.CrossRefGoogle Scholar
  76. 76.
    Setzen G, Ferguson BJ, Han JK, et al. Otolaryngol Head Neck Surg. 2012;147(5):808–16.CrossRefPubMedPubMedCentralGoogle Scholar
  77. 77.
    Anzai Y, Jarvik JG, Sullivan SD, et al. Am J Rhinol. 2007;21(4):444–51.CrossRefPubMedPubMedCentralGoogle Scholar
  78. 78.
    Balk EM, Zucker DR, Engels EA, et al. J Gen Intern Med. 2001;16(10):701–11.CrossRefPubMedPubMedCentralGoogle Scholar
  79. 79.
    Wald ER, Nash D, Eickhoff J. Pediatrics. 2009;124(1):9–15.CrossRefPubMedPubMedCentralGoogle Scholar
  80. 80.
    Chow AW, Benninger MS, Brook I, et al. Clin Infect Dis. 2012;54(8):e72–e112.CrossRefGoogle Scholar
  81. 81.
    Triulzi F, Zirpoli S. Pediatr Allergy Immunol. 2007;18(Suppl 18):46–9.CrossRefPubMedPubMedCentralGoogle Scholar
  82. 82.
    Al-Qudah M. Int J Pediatr Otorhinolaryngol. 2008;72(6):817–21.CrossRefPubMedPubMedCentralGoogle Scholar
  83. 83.
    Smith TL, Kern R, Palmer JN, et al. Int Forum Allergy Rhinol. 2013;3(1):4–9.CrossRefPubMedPubMedCentralGoogle Scholar
  84. 84.
    Anzai Y, Weymuller EA Jr, Yueh B, et al. Arch Otolaryngol Head Neck Surg. 2004;130(4):423–8.CrossRefPubMedPubMedCentralGoogle Scholar
  85. 85.
    Senbil N, Gurer YK, Uner C, et al. J Headache Pain. 2008;9(1):33–6.CrossRefPubMedPubMedCentralGoogle Scholar
  86. 86.
    Lee HS, Majima Y, Sakakura Y, et al. Nihon Jibiinkoka Gakkai kaiho. 1991;94(9):1250–6.CrossRefPubMedPubMedCentralGoogle Scholar
  87. 87.
    Bhattacharyya N, Jones DT, Hill M, et al. Arch Otolaryngol Head Neck Surg. 2004;130(9):1029–32.CrossRefPubMedPubMedCentralGoogle Scholar
  88. 88.
    Cotter CS, Stringer S, Rust KR, et al. Int J Pediatr Otorhinolaryngol. 1999;50(1):63–8.CrossRefPubMedPubMedCentralGoogle Scholar
  89. 89.
    Daele JJ. Acta Otorhinolaryngol Belg. 1997;51(4):285–304.PubMedPubMedCentralGoogle Scholar
  90. 90.
    Lieu JE, Piccirillo JF, Lusk RP. Otolaryngol Head Neck Surg. 2003;129(3):222–32.CrossRefPubMedPubMedCentralGoogle Scholar
  91. 91.
    Adappa ND, Coticchia JM. Am J Otolaryngol. 2006;27(6):384–9.CrossRefPubMedPubMedCentralGoogle Scholar
  92. 92.
    Middlebrooks EH, Frost CJ, De Jesus RO, et al. AJNR Am J Neuroradiol. 2015;36(8):1529–35.CrossRefPubMedPubMedCentralGoogle Scholar
  93. 93.
    DelGaudio JM, Swain RE Jr, Kingdom TT, et al. Arch Otolaryngol Head Neck Surg. 2003;129(2):236–40.CrossRefPubMedPubMedCentralGoogle Scholar
  94. 94.
    Groppo ER, El-Sayed IH, Aiken AH, et al. Arch Otolaryngol Head Neck Surg. 2011;137(10):1005–10.CrossRefPubMedPubMedCentralGoogle Scholar
  95. 95.
    Nadkarni T, Goel A. J Postgrad Med. 2005;51(Suppl 1):S37–41.PubMedPubMedCentralGoogle Scholar
  96. 96.
    Zamora CA, Oppenheimer AG, Dave H, et al. J Comput Assist Tomogr. 2015;39(2):228–31.CrossRefPubMedPubMedCentralGoogle Scholar
  97. 97.
    Arulrajah S, Symons H, Cahoon EK, et al. Eur J Pediatr. 2012;171(2):375–81.CrossRefPubMedPubMedCentralGoogle Scholar
  98. 98.
    Hagtvedt T, Aalokken TM, Notthellen J, et al. Eur Radiol. 2003;13(5):976–80.PubMedPubMedCentralGoogle Scholar

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Authors and Affiliations

  1. 1.Department of RadiologyUniversity of UtahSalt Lake CityUSA

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