Although transillumination and endoscopy may be helpful in the diagnosis of sinusitis in selected individuals, standard radiographs, or better yet computerized tomography, confirm the diagnosis. Magnetic resonance imaging is preferred when fungal sinusitis and various tumors are suspected. Nasal cytology is useful in the clinical evaluation of underlying allergic rhinitis, nonallergic rhinitis with eosinophilia syndrome, nasal polyposis, and aspirin-sensitive patients. Paranasal sinus biopsy specimens may be required to determine whether a lesion is neoplastic, confirm the presence of suspected fungal disease, or assess the possibility of granulomatous disease. Nasal mucosa from the posterior portion of the inferior turbinates is the preferred biopsy site for primary ciliary dysfunction.
Medications used as primary or secondary therapy for sinusitis include the following.
Although a 14-day course is usually adequate for patients with acute disease, chronic sinusitis should be treated for 8 weeks or longer. The choice of antibiotic is based on the predicted effectiveness in specific locations. Although they are not indicated for use in acute bacterial sinusitis, they may have a secondary role in ameliorating chronic sinusitis in patients with concomitant allergic rhinitis. These act to reduce turbinate swelling and improve ostial patency by their vasoconstrictive effects. These have been shown to be efficacious adjuncts to antibiotic therapy.