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Skull and Sinus

  • David M. Tierney
  • Terry K. Rosborough
  • Catherine Erickson
Chapter

Abstract

Traditional outpatient diagnosis of acute rhinosinusitis frequently results in overuse of antibiotics. Point-of-care ultrasound (POCUS) of the maxillary sinus is specific for clinically important fluid, but may miss subtle abnormalities that are rarely clinically important. The ethmoid and frontal sinuses are more challenging to image and are infrequently abnormal in isolation from the maxillary sinus. The absence of maxillary sinus fluid is a strong reason to avoid antibiotics in most patients, and helps reassure them. However, a patient with fever, severe symptoms suggestive of sinusitis, but no fluid with maxillary ultrasound, may need a computerized tomography (CT) scan to look for isolated ethmoid, frontal, or sphenoid sinusitis. A few clinical studies, and our clinic’s experience, suggest that ultrasound can substantially reduce antibiotic use for sinusitis [1–3], although there are no large randomized trials to confirm this. Only 23% of patients suspected of sinusitis in our clinic had positive ultrasound [3]. The presence of fluid does not differentiate between viral and bacterial disease, so the final antibiotic decision requires integration of ultrasound with the rest of the patient findings.

Keywords

Sinus ultrasound Sinusitis Maxillary sinus Skull fracture 

References

  1. 1.
    Varonen H, Kunnamo I, Savolainen S, Mäkelä M, Revonta M, Ruotsalainen J, et al. Treatment of acute rhinosinusitis diagnosed by clinical criteria or ultrasound in primary care. A placebo-controlled randomized trial. Scand J Prim Health Care. 2003;21:121–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Varonen H, Savolainen S, Kunnamo I, Heikkinen R, Revonta M. Acute rhinosinusitis in primary care: a comparison of symptoms, signs, ultrasound, and radiography. Rhinology. 2003;41:37–43.PubMedGoogle Scholar
  3. 3.
    Rosborough TK. Verbal communication 8/6/2016.Google Scholar
  4. 4.
    Lichtenstein D, Biderman P, Meziere G, Gepner A. The “sinusogram”, a real-time ultrasound sign of maxillary sinusitis. Intensive Care Med. 1998;24(10):1057–61.CrossRefPubMedGoogle Scholar
  5. 5.
    Vargas F, Boyer A, Bui HN, Salmi LR, Gruson D, Hilbert G. A postural change test improves the prediction of a radiological maxillary sinusitis by ultrasonography in mechanically ventilated patients. Intensive Care Med. 2007;33(8):1474–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Weinberg ER, Tunik MG, Tsung JW. Accuracy of clinician-performed point-of-care ultrasound for the diagnosis of fractures in children and young adults. Injury. 2010;41(8):862.CrossRefPubMedGoogle Scholar
  7. 7.
    Rabiner JE, Friedman LM, Khine H, Avner JR, Tsung JW. Accuracy of point-of-care ultrasound for diagnosis of skull fractures in children. Pediatrics. 2013;131:8,1757–64.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • David M. Tierney
    • 1
  • Terry K. Rosborough
    • 1
  • Catherine Erickson
    • 2
  1. 1.Department of Medical EducationAbbott Northwestern HospitalMinneapolisUSA
  2. 2.Department of Emergency MedicineOHSUPortlandUSA

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