Healthy Living

How is Sinusitis Diagnosed?

How is Sinusitis Diagnosed?

Key Takeaways

  • Most sinusitis cases are actually diagnosed based on the medical history of the patient and the examination of the doctor.
  • More detailed tests like the CT or MRI scans will be required if the initial medication is found ineffective.
  • At times, the doctor may need to perform sinus needle puncture and aspiration to determine which microbe is causing the infection.

Sinus infection or sinusitis can be diagnosed by a qualified medical practitioner after a series of tests and examinations. Most cases are actually diagnosed based on the medical history of the patient and the examination of the doctor. This is because the more effective procedures like the MRI and CT scans are costly and out of reach for many, and they are not available in most doctors’ offices. These are some of the physical symptoms the doctor normally looks for when examining a patient:

     i.   Swelling around the eyes and cheek areas.

     ii.  Tenderness on the forehead and cheek sections.

     iii. Pus release through the nasal passages.

     iv. Swelling and redness in the nasal passages.

The patient's nasal secretions are at times checked for secreted cells that can help determine whether the sinusitis is infectious or allergic. In the case of infectious sinusitis, polymorphonuclear cells will be present in the nasal secretions.  On the other hand, eosinophils cells will be found in the case of allergic sinusitis. If the patient’s infection is bacterial, antibiotics alone can be used as treatment. However, if the infection is viral, further treatment may be needed.

More detailed tests like the CT or MRI scans will be required if the initial medication is found ineffective. Ultrasound can be used to detect sinusitis in pregnant women but it’s not as detailed as the CT and MRI scans. Blockages in the sinus openings, due to growths or swelling, can be checked through a procedure called rhinoscopy or endoscopy. It involves using a flexible fiber optic tube to survey the nasal passages directly.

At times, the doctor may need to perform sinus needle puncture and aspiration to determine which microbe is creating the infection. Non-infecting bacteria normally settle in the nasal passages making the culturing of nasal passages seldom helpful in telling which bacteria or fungi are the cause of sinus infection. An otolaryngologist comes in to perform the needle puncture procedure if the initial treatments are ineffective. The patient may need to be sedated during this procedure to minimize any pain and discomfort. The contents of the sinuses are then cultured and stained. If sinus infection is detected, the sinus cavity is then usually flushed with a saline solution to clean it out. The needle puncture and aspiration procedure is probably the most accurate in detecting any infectious sinusitis.

An otolaryngologist can also be called upon to perform both flexible and rigid endoscopy to collect diagnostic material from the sinuses. In some cases, a patient may need to be sedated or given anesthesia when undergoing this procedure. The contents found after performing an endoscopy are said to be similar to those gotten by needle puncture.

Fungal infections can be diagnosed by either biopsy procedures performed by a surgeon to remove the tissues, or microscopic identification and fungal culture done by a qualified pathologist or microbiologist. Allergic fungal sinus infection is an explosive reaction to fungal components in the sinus and may be detected based on a number of symptoms found in the CT imaging. The patient's medical history and physical examinations can also play a part in detecting these inflammatory responses.

 

Who treats sinusitis infections?

Most sinusitis cases can be easily handled by any qualified doctor. However, it’s common for an ENT specialist, allergist or immunologist to handle a patient with sinusitis, otherwise called sinus infections. Surgeons who have specialized in sinus surgeries may be required in special cases.

 

Are antibiotics vital in the treatment of sinus infections?

Antibiotic treatment may not be required in the case of virus infections. Normally, medications for relieving pain and fever are recommended in the treatment of viral infections. Some of these medications are acetaminophen (e.g. Tylenol), decongestants, mucolytics, and other medications that help in dissolving mucus.

When symptoms such as pain in the cheeks and forehead or pus from the nasal passage come into play and persist for a long period of time, the infection is suspected to be bacterial. Bacterial infections might not respond to pain and fever relieving treatment. Antibiotic therapy is necessary in this situation and very effective in eliminating the most common bacteria that cause sinus infection, i.e., Streptococcus pyogenes, Moraxella catarrhalis, Haemophilus influenza, Staphylococcus aureus and Streptococcus pneumoniae. Treatment for bacterial infection should get rid of these bacteria. Drugs such as Amoxil (amoxicillin) and Augmentin (amoxicillin-clavulanate) are the most commonly used antibiotics by medical practitioners as the first treatment. This is due to their undeniable ability to destroy most of the bacteria causing the acute sinus infection.

However, other drugs such as clarithromycin (Biaxin), cefaclor (Ceclor), loracarbef (Lorabid), trimethoprim (Bactrim, Septra),  azithromycin (Zithkromax), Gantanol (sulfamethoxazole) and Cipro (ciprofloxin) are the first choice drugs when the patient is allergic to penicillin. They can also be prescribed to the patient if there is no improvement after five days of taking Amoxil or Augmentin. It generally takes a minimum of 10-14 days of effective antibiotic medication to get rid of the infection. However, it’s common for the treatment to take up to 14-21 days to get rid of the infection completely.

 

Decongestants and nasal sprays that cure or soothe sinus infections

Decongestants and mucolytics can be taken orally to assist in draining out the sinuses. Chronic types of sinus infection require treatment that involves long doses of medication like Amoxil and the patient may need to undergo thorough sinus drainage.  Sinus drainage involves opening the blocked sinus through a surgical operation. Antihistamines should be avoided until it’s clear that the sinus infection has been caused by an allergy. It is possible for a nasal spray to reduce swelling in allergic sinus infection on its own, but sometimes it can be used together with antihistamines for drying. Oral steroids can be prescribed to the patient to reduce intense inflammation and to assist in chronic inflammation in situations with or without polyps and in allergic fungal sinus infection.

In most cases, allergic sinusitis come first, and bacterial infection follows later. Patients in this kind of situation can get cured before the allergic sinusitis develops into bacterial sinusitis. In rare situations, a deadly fungal infection may attack weak individuals. Reports suggest that 50%-85% of these individuals die if the infection is not detected and treated early enough. Whether the victim will get better or worse solely depends on early detection followed by antifungal drugs, surgery, or any other appropriate treatment.

 

Complications that can come with sinus infection

It is rare for serious complications to be experienced in the case of sinusitis. However, it is possible for the infection to bring about life-threatening emergencies. One of these complications can occur if the infection moves into the brain through the sinus wall leading to a serious medical condition like meningitis. Other parts that are adjacent to the affected area can also get infected, leading to problems like infection affecting the area around the eye and osteomyelitis, which affects the bones of the skull.

Bacterial and fungal infections rarely lead to life-threatening situations. This only happens if the infections are not diagnosed and treated in time or if the infected individual has a weak immune system due to any number of factors. It is of paramount importance to visit your doctor if you experience symptoms that suggest the presence of sinusitis--especially the ones that last for longer periods.