Adult Chronic Sinusitis and Its Complications

By G. Douglas Campbell Jr., MD, FCCP

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Radiologic Examination

Historically, the physician relied upon plain radiographic examination of the sinuses (Waters occipitomental view, Caldwell occipitofrontal view, and a lateral view to visualize the sphenoid sinuses) to determine if the patient had chronic rhinosinusitis. Plain radiologic examination for chronic rhinosinusitis is sometimes helpful, especially if an air fluid level is seen (which is unusual), but because of interobserver error, the presence of normal anatomical anomalies, and poor correlation between the extent of sinus abnormality and symptom severity, other radiographic tests are used.²³

Presently, contiguous coronal CT scanning of the sinuses is considered the gold standard. Coronal CT scanning is better able to identify anatomic abnormalities, identify mucosal thickening, and quantitate severity of illness; it can also be used to detect nasal polyps that originate in the paranasal sinuses (Fig 1, Fig 2).^24,25 A limiting factor in using coronal CT scanning is cost. While coronal CT scanning is necessary if surgical intervention is being considered, in the routine medical treatment of chronic rhinosinusitis, at least one author suggests that CT scanning be reserved for cases in which symptoms persist after maximal medical management, there are complications of therapy, or the clinician suspects cancer.^26,27

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