Investigations

In primary care, acute rhinosinusitis (ARS) is a clinical diagnosis based on history and clinical features (1). There is no role for imaging or detailed ENT examinations for suspected ARS in primary care (2).

Anterior rhinoscopy (with an otoscope or Thudichum’s nasal speculum with headlight, depending on availability) can be carried out in primary care setting as part of the clinical assessment of suspected ARS. It may reveal supportive findings such as

• nasal inflammation
• mucosal oedema
• purulent nasal discharge
• previously unsuspected findings such as polyps or anatomical abnormalities (1).

CT may be considered in very severe disease, in immuno-compromised patients, when there is suspicion of complications (1)

Notes:

• CT
  • CT of the paranasal sinuses provides valuable information but this should be interpreted in the context of the history and examination as the prevalence of incidental mucosal changes in an asymptomatic population is approximately 30% (4)

Reference:

1. Fokkens WJ et al.European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinol Suppl. 2012;23:3 p
2. Foden N, Burgess C, Shepherd K, Almeyda R. A guide to the management of acute rhinosinusitis in primary care management strategy based on best evidence and recent European guidelines. The British Journal of General Practice. 2013;63(616):611-613.