From the Guidelines
Facial X-rays are not recommended for diagnosing sinus infections due to their low accuracy and the availability of better imaging modalities like CT scans. According to the American College of Radiology, plain films of the sinuses, including facial X-rays, are inaccurate in a high percentage of patients and should be supplanted by CT imaging 1. The sensitivity and specificity of sinus radiography are moderate, with a sensitivity of 76% and specificity of 79% compared to sinus puncture in diagnosing acute bacterial rhinosinusitis (ABRS) 1.
Key Points to Consider
- Sinus involvement is common in documented viral upper respiratory infections (URIs), making it impossible to distinguish ABRS from viral rhinosinusitis (VRS) based solely on imaging studies 1.
- Clinical criteria may have a comparable diagnostic accuracy to sinus radiography, and radiography is not cost-effective regardless of baseline sinusitis prevalence 1.
- Imaging studies, such as CT scans, may be obtained when a complication of ABRS or an alternative diagnosis is suspected, or when the patient has modifying factors or comorbidities that predispose to complications 1.
Diagnosis and Imaging
When diagnosing sinus infections, doctors typically rely on symptoms and physical examination, reserving imaging for severe, recurrent, chronic, or unresponsive cases 1. CT imaging of the sinuses is appropriate when a complication of ABRS is suspected, and it can provide better detail of the sinus anatomy than facial X-rays 1. MRI scans may be used in certain complicated cases, such as suspected orbital, intracranial, or soft tissue involvement 1.
From the Research
Facial X-ray and Sinus Infection
- A facial X-ray may show signs of sinus infection, but it is not the most effective diagnostic tool for this purpose 2.
- According to a study published in the American Family Physician, plain radiography has a limited role in the management of sinusitis, and its findings are not specific for sinusitis 2.
- The study suggests that noncontrast coronal computed tomographic (CT) images can define the nasal anatomy more precisely and are more effective in diagnosing sinusitis 2.
Diagnostic Criteria for Sinus Infection
- Acute, uncomplicated rhinosinusitis is a clinical diagnosis, and imaging should only be used in cases of complicated sinus infections, recurrent or chronic sinus disease, or in surgical planning 3.
- A study published in the Cleveland Clinic Journal of Medicine discusses the key features of complicated and uncomplicated rhinosinusitis, management, and recommendations on the use of imaging in diagnosis 3.
Treatment of Sinus Infection
- The treatment of sinus infection typically involves antibiotics, and the choice of antibiotic depends on the severity and type of infection 4, 5, 6.
- A study published in the American Journal of Otolaryngology compared the efficacy and tolerability of azithromycin and amoxicillin/clavulanate in the treatment of acute sinusitis, and found that azithromycin was as effective and well-tolerated as amoxicillin/clavulanic acid 4.
- Another study published in JAMA Network Open found that high-dose amoxicillin plus clavulanate did not provide significant benefits over standard-dose amoxicillin plus clavulanate in adults with acute sinusitis 5.