From the Guidelines
Diagnostic Criteria for Acute Sinusitis
Diagnosis of acute sinusitis is primarily based on clinical presentation, with symptoms persisting for more than 10 days or worsening after 5-7 days, including nasal congestion, facial pain, and purulent nasal discharge 1.
Key Diagnostic Factors
- Persistent illness with nasal discharge of any quality and/or daytime cough lasting for more than 10 days without improvement 1
- Severe onset of symptoms with concurrent fever (temperature ≥ 39°C) and purulent nasal discharge for at least 3 consecutive days 1
- Clinical presentation and physical examination findings, such as nasal turbinate edema, purulent discharge, and sinus tenderness 1
- Imaging studies, including computed tomography scans, may be used to confirm the diagnosis and rule out other conditions, such as orbital or intracranial complications 1
Important Considerations
- Viral upper respiratory tract infections often precede acute bacterial sinusitis, and distinguishing between viral and bacterial sinusitis can be challenging 1
- Imaging abnormalities alone are not sufficient for the diagnosis of acute sinusitis, as paranasal sinus opacification is often present in healthy individuals or those with viral upper respiratory tract infections 1
- Laboratory tests, such as complete blood count and blood cultures, are not typically necessary for diagnosis, but may be considered in severe or complicated cases 1
From the Research
Diagnostic Criteria for Acute Sinusitis
The diagnostic criteria for acute sinusitis, also known as inflammation of the paranasal sinuses, can be identified through various clinical signs and symptoms.
- Purulent secretion as a symptom experienced by the patient or as a sign demonstrated in the nasal cavity by the doctor 2
- Pain in the teeth 2
- Pain at bending forward 2
- Two phases in the illness history 2
- An elevated erythrocyte sedimentation rate and increased C-reactive protein also contributed to the diagnosis 2
- Purulent nasal discharge with nasal obstruction and/or facial pain-pressure-fullness lasting between 10 days and 4 weeks 3
- Maxillary toothache, lack of improvement with decongestants, a purulent nasal discharge, cough, purulent secretions observed on nasal examination, abnormal transillumination, and sinus tenderness 4
- Persistent symptoms of viral URI (nasal drainage and or cough) for more than 10 days, severe symptoms of a URI accompanied by fever >102.2°F and purulent nasal drainage for at least 3 days, or worsening of symptoms after initial improvement 5
- Continuation of symptoms after a typical cold has subsided, thick, purulent, green or deep yellow secretions in the nasal passages, nasal obstruction and purulent post-nasal drip 6
Imaging and Laboratory Tests
Imaging studies such as plain film radiographs, computed tomography (CT) scans, and sinus roentgenograms can be used to confirm the diagnosis of acute sinusitis 3, 4, 6.
- CT scans provide superior visualization of the sinuses, but may not be necessary for routine cases 4
- Laboratory tests such as erythrocyte sedimentation rate and C-reactive protein can also be used to support the diagnosis 2
Special Considerations
In children, acute bacterial sinusitis (ABS) can be diagnosed based on clinical presentation, and imaging studies are not recommended unless intracranial or orbital complications are suspected 5.
- In the elderly, the clinical presentation of sinusitis may be subtle, and the condition may not be readily diagnosed 6