Diagnosis of rhinosinusitis

Medical history. Patients with symptoms of acute rhinosinusitis will be asked questions and their case history recorded (anamnesis) and, if possible, a nasal endoscopy to determine whether they meet the specific criteria. Imaging tests are only carried out in patients where the diagnosis is unclear or who present a slow evolution. In patients suspected of chronic rhinosinusitis, besides the interview, they will also undergo a nasal endoscopy and imaging tests.

Nasal endoscopy. A rigid or flexible endoscope with a fibre optic light is inserted in the patient’s nose to obtain a view of the nasal cavity. The test is also called nasofibroscopy.

Imaging tests. Images obtained from a computed tomography or magnetic resonance imaging study can reveal details about the paranasal sinuses and nasal area. These images can help produce an accurate view of deep inflammation or a physical obstruction that is hard to identify with an endoscope. It has recently been demonstrated that X-rays of the paranasal sinuses are completely unnecessary for the diagnosis of rhinosinusitis (both acute or chronic).

Olfactometry. This test is used to evaluate the sense of smell.

Nasal cultures. In general, cultures are not required for the diagnosis of chronic rhinosinusitis. Nevertheless, if the condition does not respond to treatment or worsens, tissue cultures can help determine the cause, e.g., whether bacterial or fungal.

Allergy test. If the doctor suspects the complaint is caused by an allergy, they may recommend an allergy skin test. Allergy skin tests are safe, quick and can help accurately identify the allergens responsible for any pain and discomfort in the nose.