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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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Tags: Ear Nose and Throat Infection Tag this Diagnosis.

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

Specific Findings

Finding SensitivitySpecificity Comments, Study
Maxillary Toothache Edit 18%93%

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

Negative Findings

Finding SensitivitySpecificity Comments, Study
Fever Edit 45%51%

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

Headache Edit 68%30%

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

Poorly Diagnostic Findings

Finding SensitivitySpecificity Comments, Study
Ultrasound Edit 76%84%

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

Plain X-Ray Edit 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 Edit 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 Edit 41%80%

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

Purulent Secretion Edit 51%76%

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

Nasal Speech Edit 45%73%

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

Sinus Tenderness Edit 48%65%

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

Preceding URI Edit 50%61%

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

Transillumination Edit 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 Edit 72%52%

(as a symptom, not sign)

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

Facial Pain Edit 52%48%

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

Cough Edit 70%44%

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

Findings With Unspecified Accuracy

Finding SensitivitySpecificity Comments, Study
Non-contrast Head CT Edit 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