From the Guidelines
The findings of a sinusitis examination typically include symptoms such as nasal congestion, purulent rhinorrhea, facial pain, headache, and cough, as well as physical examination findings like mucosal erythema and purulent secretions, and may also involve imaging studies like CT scans in certain cases. When evaluating a patient with suspected sinusitis, it is essential to consider the duration and character of symptoms, including facial pain/pressure, nasal congestion, purulent discharge, and hyposmia, as well as relevant past medical history 1. The physical examination should include vital signs, general appearance, nasal examination (mucosal status, discharge, polyps), facial tenderness over sinuses, oropharyngeal examination, and otoscopic findings. Key findings may also include:
- Nasal congestion and purulent rhinorrhea
- Facial pain or pressure
- Headache and cough
- Mucosal erythema and purulent secretions on nasal examination
- Facial tenderness over sinuses
- Oropharyngeal examination findings like pharyngeal erythema and lymphoid hyperplasia
- Otoscopic findings like middle ear effusions The diagnosis of sinusitis is based on a combination of clinical history, physical examination, imaging studies, and/or laboratory tests 1. Imaging studies like CT scans may be necessary in certain cases, such as when complications are suspected or when the diagnosis is unclear 1. The assessment should classify the sinusitis as viral, acute bacterial, or chronic, noting any complications, and the plan should outline medications prescribed, follow-up timing, and indications for earlier return 1. It is crucial to prioritize the patient's morbidity, mortality, and quality of life when making treatment decisions, and to consider the most recent and highest-quality evidence available 1.
From the FDA Drug Label
1.3 Sinusitis – caused by beta-lactamase–producing isolates of H. influenzae and M. catarrhalis. The findings of a sinusitis examination are not directly stated in the drug label. Key points:
- The drug label mentions sinusitis as an indication for the use of amoxicillin-clavulanate potassium tablets USP.
- It specifies that the sinusitis should be caused by beta-lactamase–producing isolates of H. influenzae and M. catarrhalis. However, the label does not provide information on the specific findings of a sinusitis examination. 2
From the Research
Findings of a Sinusitis Examination
The findings of a sinusitis examination can be summarized as follows:
- Diagnosis of sinusitis depends on obtaining a complete history and physical examination, in addition to the use of radiographic diagnostic aids and, if necessary, sinus aspiration 3
- Symptoms of sinusitis include nasal congestion, rhinorrhoea, facial pain, hyposmia, sneezing, and, if more severe, additional malaise and fever 4
- Clinical signs and symptoms most helpful in the diagnosis of maxillary sinusitis are the presence of a maxillary toothache, lack of improvement with decongestants, a purulent nasal discharge, cough, purulent secretions observed on nasal examination, abnormal transillumination, and sinus tenderness 5
- Adjunctive tests in selected cases include nasal cytologic studies, ultrasound studies, and the use of flexible or rigid nasal endoscopes, in addition to imaging tests such as radiology and computed tomography 6
Diagnostic Tests
Diagnostic tests for sinusitis include:
- Physical examination to exclude anatomic causes of symptoms 6
- Nasal cytologic studies to detect the presence of inflammation or infection 6
- Ultrasound studies to visualize the sinuses and detect any abnormalities 6
- Flexible or rigid nasal endoscopes to visualize the nasal passages and sinuses 6
- Imaging tests such as radiology and computed tomography to visualize the sinuses and detect any abnormalities 3, 5
Complications of Sinusitis
Complications of sinusitis include: