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Acute sinusitis: diagnosis
Last reviewed: 23.04.2024
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Phyical examination
Important in the detection of sinusitis is the consistent conduct of anterior, middle and posterior rinoscopy. Rhinoscopic signs of sinusitis include: detachable in the nasal passages, hyperemia, swelling and hyperplasia of the mucous membrane.
The pathological discharge and the middle nasal passage (anterior rhinoscopy), as a rule, indicate a possible lesion of the frontal and maxillary sinuses, anterior and middle cells of the latticed labyrinth, in the upper nasal passage (posterior rhinoscopy) - about possible damage to the posterior cells of the latticed maze and the sphenoid sinus. However, the absence of a pathological spit in the cavity of the spit does not exclude sinus disease. In particular, the discharge may not be (periodically or permanently) if the patency of the sinus of the affected sinuses is violated with the nasal cavity or with a high viscosity of the separated.
Laboratory research
A clinical blood test confirms the presence of an inflammatory process and indirectly characterizes its intensity (ESR, the number of leukocytes, the ratio of different forms of leukocytes).
Microbiological studies of punctate allow to identify the causative agent and determine its sensitivity to various antibiotics. Unfortunately, with acute sinusitis, the data of microbiological examination can be obtained only on the 3rd-4th day after the onset of the disease and when empiric therapy is prescribed, they lose their relevance.
Instrumental research
To clarify the diagnosis, establish the nature and prevalence of lesions of the paranasal sinuses, special methods of investigation are used: X-ray and diagnostic puncture of the sinuses.
X-ray methods for the study of paranasal sinuses are one of the most common methods in the diagnosis of sinusitis, which allow one to judge the presence or absence of sinuses, their shape, size, and the nature and localization of the pathological process. A radiological sign of sinusitis is considered to be a decrease in the pneumatization of the paranasal sinuses, sometimes a horizontal level of exudate can be seen on the roentgenogram.
To clarify the degree and nature of the defeat of the paranasal sinuses, it is advisable to conduct studies in several projections. The most common straight projections (frontal-nasal, naso-chin) and lateral.
When assessing the degree of pneumatization of the paranasal sinuses, it is common to compare the sick and healthy sides. However, with polisinusitah this method is impossible to use. In this connection, when reading the radiographs, a comparison is made between the pneumatization of the sinuses and the fairly stable transparency of the orbit.
Puncture of the paranasal sinuses both for diagnostic and for therapeutic purposes has found wide application in practice. Currently, the most frequently performed puncture of the maxillary sinus through the lower nasal passage.
Of the new auxiliary tools for diagnosing diseases of the paranasal sinuses, mention should be made of thermography, diagnostics using pulsed ultrasound, thermal imaging, CT, MRI.
Summarizing the variety of diagnostic methods, it is necessary to identify the main methods that provide a correct, timely diagnosis of sinusitis. Recognition of the disease largely depends on the correct clinical examination of the patient. In particular, fully collected complaints and anamnesis, a rational assessment of the data of the anterior, middle and posterior rhinoscopy, an objective interpretation of the radiographic data, and sinus puncture. Clinical analysis of the results of such a survey allows in most cases to put or reject the diagnosis of sinusitis and determine its shape.
Differential diagnosis of acute sinusitis
Differential diagnosis of acute sinusitis is performed with trigeminal neuralgia (middle and upper branches), paresthesias, tooth pathology of the upper jaw, headaches of various etymologies (hypertension, vascular spasms, etc.).
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