Radiologic Imaging in the Management of Sinusitis -- American Family Physician

www.aafp.org/afp VOLUME 66, NUMBER 10 / NOVEMBER 15, 2002 plete opacification are more specific for sinusitis but are seen in only 60 percent of sinusitis cases. Interpretation of plain radiographs can vary widely among different observers,and there is a high rate of false-negative results. Radiographs of the sinuses in infants aged three years or younger are not useful because of false “opacification” from undeveloped sinuses. Other important limitations of plain radiographs include poor visualization of ethmoid air spaces and difficulty differentiating between infection, tumor, and polyp in an opacified sinus. Because clinical judgment is sufficient to diagnose sinusitis in a majority of cases, and empiric treatments are inexpensive and safe, only a small percentage of patients who develop recurrent or complicated sinusitis are candidates for imaging studies. Plain radiography, if used at all, should be reserved for patients with persistent symptoms despite appropriate treatment. A single Waters’ view (occipitomental) appears to provide as much information as the standard four-view series.