The Diagnostic Value of Sinus

Radiography
in the Evaluation of Sinusitis
Citra Permata 03013047
Dini Esfandiari 03013056
Acute or chronic sinusitis is a common illness among adults and children. Sinus radiography is
the primary imaging study that most otolaryngologists utilize when diagnosing sinusitis.

Clinically, otolaryn-gologists often rely on X-ray images to evaluate the further need for sinus
computed tomography (CT), to discover fluid or pus accumulation and determine whether
medical treatment or functional endoscopic sinus surgery is indicated.

This study aimed to evaluate the diagnostic value of sinus radiography for diagnosing sinusitis by
comparing with sinus CT.
Methods and Materials
42 patients (26 males and 16 females) clinically diagnosed with sinusitis presented by symptoms of
sinusitis such as nasal obstruction, postnasal drip, mucus or pus-like nasal discharge, and halitosis in
the nasal cavity.

Ages ranged from 5 to 83 years, with an average of 52.3 years.

No history of trauma and neoplasm.

All of them received both sinus radiography and sinus CT , which were performed within 2 weeks
between each other.

The sinus radiography included Waters, Caldwells, and lateral views.

Radiologists and radiographic technologists reviewed the X-ray images from the Picture Archiving and
Communication System (PACS) and identified signs of sinusitis including fluid accumulation and
opacification in every paranasal sinus
Result and Discussion

The overall sensitivity of sinus radiography in identifying sinus fluid was 92.9%
Among all paranasal sinuses, sinus radiography had higher sensitivities for fluid accumulation in maxillary and frontal
sinuses (88.6% and 88.9%, respectively), but lower sensitivities for discerning fluids in the ethmoid and sphenoid sinuses
(57.1% and 28.6%)
False negative result may be due to the 3-dimensional shape of the head and superimposition of
cranial bones and soft tissue structures.
False positive result may be due to anatomical superimposition of cranial bones structure and
ambiguities stemming from tissue superimposition, technical failure of appropriate patient
positioning and X-ray tube angling motion artifacts.
Radiographic exposure conditions also result in too dark or bright images due to excessive or
inadequate kilovoltage (KV) or milliampere seconds (MAS), so that images may decrease sinus
transradiancy and produce similar opacification phenomenon, resulting in false positive
situation.
Considering both pathological changes and the complex anatomic structures of the human skull,
radiography does not always provide accurate discernment of fluids or opacification in the
ethmoid, sphenoid, and frontal sinuses.
Hence, sinus CT is useful when the accurate location, extent, and severity of sinus fluid require
confirmation.
All studies unanimously agreed that localized, low- radiation, and high-resolution sinus CT is
strongly indicated in a few locations such as the ethmoid and sphenoid sinuses where
radiographic detection of abnormality may be difficult.
According to the literature, three different sinus radiography views are suggested for diagnosing
fluid accumulation or opacification in adults and older children, while only the Waters view is
required for preschool-aged children.
When X-ray images reveal obvious fluid accumulation or opacification in paranasal sinuses of the
patients presents with severe clinical signs of sinusitis, antibiotic should be instituted. If the
symptoms and signs persisted despite of adequate medical treatment, then sinus CT will be
suggested to evaluate underlying anatomic occlusion of paranasal sinuses or other complicated
condition.
Conclusion
Because of the high sensitivity for paranasal sinus fluid accumulation or opacification, sinus
radiography still plays an essential clinical role in assessing sinusitis for otolaryngologists.
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