Diagnosis

Patients should see a doctor if they have sinusitis symptoms that do not clear up within a few days, are severe, or are accompanied by high fever or acute illness.

Some doctors believe that too many patients are diagnosed with true sinusitis and given unnecessary antibiotics when their symptoms would actually resolve easily in days with over-the-counter medications or no drugs at all.

The first goal in diagnosing sinusitis is to rule out other possible causes of symptoms, and then determine:

• The site where the infection has occurred
• Whether the condition is acute or chronic
• The organism causing the infection (if possible)

Diagnostic Approach to Acute Sinusitis

Medical History. The patient should describe all symptoms such as nasal discharge and specific pain in the face and head, including eye and tooth pain.

After assessing symptoms, the doctor should take a thorough medical history of the patient:

• Any history of allergies or headaches
• Recent upper respiratory infection (colds, flu, infection) and how long they have lasted
• History of sinusitis episodes that is unresponsive to antibiotic treatment. (In such cases, the doctor will usually diagnose chronic or recurrent acute sinusitis and may refer the patient to a specialist for more advanced testing.)
• Exposure to cigarette smoke or other environmental pollutants
• Recent travel (especially by air), scuba diving
• Recent dental procedures
• Medications being taken (particularly decongestants)
• Any known structural abnormalities in the nose and face
• Injury to the head or face
• History of medical conditions that can produce tender areas in the face or sinus regions and nonspecific symptoms of ill health
• Any family history of allergies, immune disorders, cystic fibrosis, or Kartagener's (immotile cilia) syndrome
• In small children with sinusitis, whether they attend a day care center or nursery school

Physical Examination

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Review Date: 05/10/2010
Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)