From the Guidelines
Incidental sinus opacification found on CT typically does not require treatment if the patient has no symptoms. If you're experiencing no sinus-related symptoms like congestion, facial pain, or drainage, watchful waiting is appropriate as these findings are common in the general population and often resolve on their own 1. However, if you develop symptoms such as facial pressure, nasal congestion, thick nasal discharge, or post-nasal drip, treatment may include saline nasal irrigation (using a neti pot or similar device twice daily with sterile saline solution), intranasal corticosteroids like fluticasone (2 sprays in each nostril once daily) or mometasone, and possibly antihistamines if allergies are suspected 1.
Key Considerations
- Antibiotics are generally not recommended unless there are clear signs of bacterial infection persisting beyond 10 days or worsening after initial improvement 1.
- The reason incidental findings often don't require treatment is that the paranasal sinuses normally contain some fluid and tissue, and CT scans are highly sensitive at detecting even minor mucosal thickening that may represent normal physiological variations rather than pathology.
- Radiographic imaging of the paranasal sinuses is unnecessary for diagnosis in patients who already meet clinical diagnostic criteria for acute bacterial rhinosinusitis (ABRS) 1.
Treatment Approach
- Treatment should be based on the presence of symptoms and clinical diagnostic criteria, rather than incidental findings on CT scans.
- Patients with symptoms such as facial pressure, nasal congestion, thick nasal discharge, or post-nasal drip should be treated with saline nasal irrigation, intranasal corticosteroids, and possibly antihistamines if allergies are suspected 1.
- Antibiotics should only be used in cases of clear bacterial infection, and not as a first-line treatment for incidental sinus opacification 1.