Acute Sinusitis: Likelihood Ratios

Introduction: A bacterial infection of one or multiple of the paranasal sinuses (frontal, maxillary, or ethmoid). The gold standard is typically direct puncture and aspiration of purulent fluid.

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Prevalence

Population / Calculator	Prevalence	Comments / Study / Link
Adults in the US	11.6%	https://www.cdc.gov/nchs/fastats/sinuses.htm
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The likelihood ratios of findings for Acute Sinusitis are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Good Positive and Negative Likelihood Ratios
Finding	Result	+LR	-LR
[ + ] Ultrasound	+ 0 -	4.8	0.3
Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391
[ + ] Unilateral Nasal Discharge and Unilateral Pain	+ 0 -	4.4	0.3
Study: Acta Otolaryngol. 1988 Mar-Apr;105(3-4):343-9. PMID: 3389120 as cited in J Fam Pract. 2003 Jul;52(7):563-5. PMID: 12841974
[ + ] Plain X-Ray	+ 0 -	3.8	0.5
air-fluid level or opacification Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391

Good Negative Likelihood Ratio
Finding	Result	+LR	-LR
[ + ] Transillumination	+ 0 -	1.6	0.5
Transillumination should be performed with a transilluminator in a completely darkened room, after the examiner's eyes have adapted to darkness. The frontal sinus is examined by shining a light superiorly through the supraorbital ridge and observing transmission through the forehead. The maxillary sinus is tested by shining a light through the sinus from the infraorbital area and observing transmission through the hard palate. Transillumination of the sinuses was clinically useful in two studies but not in a third. Twenty percent to 40% of sinuses have indeterminate or "dull" results, as opposed to the more definitive "normal" or "opaque." Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391
[ + ] Colored Discharge	+ 0 -	1.5	0.5
(as a symptom, not sign) Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391

Good Positive Likelihood Ratio
Finding	Result	+LR	-LR
[ + ] Maxillary Toothache	+ 0 -	2.6	0.9
Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391
[ + ] Purulent Secretion	+ 0 -	2.1	0.6
Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391
[ + ] No improvement with Decongestants	+ 0 -	2.1	0.7
Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391

Findings With Unspecified Accuracy
Finding	Result	+LR	-LR
[ + ] Non-contrast Head CT		No accuracy specified.
Approximately 42% of healthy persons and up to 87% of patients with colds have abnormal sinuses on CT. Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391 J Fam Pract. 2003 Jul;52(7):563-5. PMID: 12841974

Poorly Diagnostic Findings
Finding	Result	+LR	-LR
[ + ] Nasal Speech	+ 0 -	1.7	0.8
Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391
[ + ] Sinus Tenderness	+ 0 -	1.4	0.8
Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391
[ + ] Preceding URI	+ 0 -	1.3	0.8
Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391
[ + ] hearing loss	+ 0 -	0.9	1.1
Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391
[ + ] Facial Pain	+ 0 -	1	1
Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391
[ + ] Cough	+ 0 -	1.3	0.7
Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391
[ + ] Headache	+ 0 -	1	1.1
Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391