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.

Good Positive and Negative Likelihood Ratios

Finding	+LR	-LR	Comments, Study
Ultrasound	4.8	0.3	Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391
Unilateral Nasal Discharge and Unilateral Pain	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	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

Transillumination

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

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	+LR	-LR	Comments, Study
Maxillary Toothache	2.6	0.9	Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391
Purulent Secretion	2.1	0.6	Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391
No improvement with Decongestants	2.1	0.7	Study: J Gen Intern Med. 1994 Jan;9(1):38-45. PMID: 7857391

Poorly Diagnostic Findings

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