Radiography and Ultrasonography in Paranasal Sinusitis

Abstract

In order to analyze whether ultrasonography with a reasonable degree of confidence can replace radiography in the diagnosis of sinusitis, 138 patients with clinical signs of sinusitis were examined with both methods. It was found that maxillary sinus fluid was recognized ultrasonographically with a confidence that increased with the amount of fluid, judged from radiographic examinations. In a sub-group of 45 cases, fluid confirmed by maxillary sinus puncture was detected by ultrasonography in 35/45 sinuses (78 %) and by radiology in 38/45 sinuses (84 %). In patients with radiographically normal maxillary sinuses, the correlation to ultrasound was good. However, mucosal swelling and polyps or cysts observed at radiography were poorly demonstrated by ultrasonography. In addition, the ultrasound method was not reliable for frontal sinus diagnosis. It was concluded that ultrasonography can be recommended in maxillary sinusitis for follow-up of treatment and as a screening method before sinus radiography.

Validity of Ultrasonography in Diagnosis of Acute Maxillary Sinusitis

“…In previous studies [5][6][7][8][9][10] comparing ultrasonography with radiography in the detection of maxillary sinusitis, the sensitivity of ultrasound ranged from 32% to 99% and the specificity ranged from 61% to 100%. The comparability of these studies, however, is limited because of extensive methodological variation.…”

“…In addition, the exact criteria used for diagnosing sinusitis by ultrasonography and radiography were reported in only 2 of these studies. 8,9 Conventionally, only ultrasound findings indicative of the presence of fluid in the sinus (echo, Ͼ3.5-4.0 cm) have been interpreted as maxillary sinusitis. 8,9,14 In radiological imaging, however, considerable mucosal thickening even in the absence of an air-fluid level is generally regarded as evidence of sinusitis.…”

“…Ultrasonography is a rapid, inexpensive, convenient, and readily available method for evaluation of maxillary si-nuses, and these features make it an optimal diagnostic method, especially in primary care. However, previous studies [5][6][7][8][9][10] on the sensitivity and specificity of ultrasonography have yielded extremely variable results, and hence the status of ultrasonography in the diagnosis of maxillary sinusitis has remained unestablished.…”

A-mode Ultrasound in the Diagnosis of Chronic Polypous Sinusitis

“…Using A-US and Xray to evaluate antral mucosal thickening in chronic sinusitis, Druce et al (1988) found the total specificity to be 61% and the sensitivity 34% (15). In a study by Jensen and von Sydow (1987) the A-US findings of mucosal thickening without fluid correlated with Xray in only 19% and different degrees of mucosal thickening were poorly demonstrable (16).…”

Diagnosis of maxillary sinusitis in Finnish primary care. Use of imaging techniques

“…The primary care setting often lacks facilities for a precise diagnosis, and general practitioners (GPs) have had to rely on their clinical judgement despite the uncertainty involved (1,4). Radiography is usually considered reliable for showing secretion in nasal cavities (5,6), while the opinions on the accuracy of the ultrasound vary (3,5,7). Ultrasonography has been promoted as an easy and readily accessible method in primary care and it is used increasingly.…”