Acute Sinusitis: Sensitivity and Specificity

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 sensitivity and specificity of findings for Acute Sinusitis are listed below. See the left navigation bar to change the display.

Specific Findings

Maxillary Toothache

18%

93%

Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391

Negative Findings

hearing loss

45%

51%

Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391

Headache

68%

30%

Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391

Poorly Diagnostic Findings

Finding	Sensitivity	Specificity	Comments, Study
Ultrasound	76%	84%	Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391
Plain X-Ray	60%	84%	air-fluid level or opacification Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391
Unilateral Nasal Discharge and Unilateral Pain	79%	82%	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
No improvement with Decongestants	41%	80%	Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391
Purulent Secretion	51%	76%	Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391
Nasal Speech	45%	73%	Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391
Sinus Tenderness	48%	65%	Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391
Preceding URI	50%	61%	Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391
Transillumination	73%	54%	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	72%	52%	(as a symptom, not sign) Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391
Facial Pain	52%	48%	Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391
Cough	70%	44%	Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391

Findings With Unspecified Accuracy

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