The diagnosis of acute sinusitis or acute rhinosinusitis (ARS; simultaneous inflammation of the nasal mucosa (“rhinitis”) and inflammation of the mucosa of the paranasal sinuses (“sinusitis“)) is initially made clinically on the basis of typical symptoms and clinical findings.
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic clarification/in case of complications.
- Anterior rhinoscopy (examination of the anterior nasal segment using a nasal speculum) or nasal endoscopy (nasal endoscopy; nasal cavity endoscopy, i.e., examination of the anterior and posterior nasal segments) possibly with biopsy (tissue sampling) – if chronic rhinosinusitis (CRS, simultaneous inflammation of the nasal mucosa (“rhinitis”) and the mucosa of the paranasal sinuses) is suspected as the method of first choice; also in the case of recurrent acute rhinosinusitis (ARS).
- Sonography (ultrasound examination) of the paranasal sinuses – if chronic rhinosinusitis (CRS) is suspected (limited assessability, therefore rarely indicated)[fluid retention in the maxillary and frontal sinuses?]
- X-ray of the paranasal sinuses – also in rhinosinusitis usually not indicated [it may show mucosal swelling, fluid levels and total shadowing, these are found in both bacterial and 40-80% of viral infections!; conventional radiographs: about 30% of sinusitis are missed, especially in the ethmoidal and sphenoidal sinuses].
- Computed tomography of the paranasal sinuses (NNH-CT; sectional imaging procedure (radiographs taken from different directions with computer-based analysis)) or digital volume tomography (DVT; three-dimensional imaging tomography procedure using X-rays) – is demonstrative of rhinosinusitis, but usually not indicated. Indications: to exclude other pathologies (or further questions in CRS) or for surgical planningNote: In 18-45% of children without CRS, abnormalities are found in the NNH-CT.
- Magnetic resonance imaging of the paranasal sinuses (NNH-MRI; computer-assisted cross-sectional imaging (using magnetic fields, that is, without X-rays)) – is demonstrative of rhinosinusitis, but usually not indicated; may also be used as a diagnostic exclusion in patients with increased radiation sensitivity (e.g., children) Indications: Tumors/intracranial complications of CRS.
