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Evidence summaries

Sinus Ultrasound and Radiography in the Diagnosis of Sinusitis

Sinus ultrasound has similar accuracy as sinus X-ray in the diagnosis of acute maxillary sinusitis. Level of evidence: "A"

Sinus ultrasound is recommended to be used in the clinical examination of the patient when maxillary sinusitis is suspected.

The recommendation is strong because ultrasound is easily available, safe (no radiation exposure) and cheap compared to radiography.

Sinus ultrasound has been compared to sinus puncture in five studies 1 2 3 4 5 on adult patients that were suspected to have acute maxillary sinusitis. These studies were combined in a meta-analysis 7. Only studies on unselected patient population are considered here (studies on e.g. only allergic patients were excluded).

In the meta-analysis of studies [R1 to R5] the weighted mean sensitivity of these studies was 0.85 (95% CI 0.84 to 0.87) and specificity 0.82 (95% CI 0.80 to 0.83). The range of sensitivity was from 0.54 to 0.94 and that of specificity 0.53 to 0.94.

In a more recent study not included in the meta-analysis 8 the ultrasound device reached sensitivity of 87% (95% Cl 81-94%) and specificity of 72% (95% Cl 64-80%) compared with sinus puncture. Positive predictive value was 75% and negative predictive value 85%. Ultrasound detected correctly all 18 sinuses in which the secretion was abundant and considered to be purulent by the physician (sensitivity and negative predictive value 100%).

Sinus radiography has been compared to sinus puncture in six studies 1 2 3 4 5 6 in patients with suspected acute maxillary sinusitis. The weighted mean sensitivity of these studies was 0.87 (95% CI 0.85 to 0.88) and specificity 0.89 (95% CI 0.88 to 0.91). The range of sensitivity was from 0.61 to 0.93 and that of specificity 0.62 to 0.98.

Sinus ultrasound has been compared to sinus radiography in two studies. In a study of 67 paediatric patients with mean age of 9 years 9, there was a diagnosis agreement between the two techniques in 112 out of 134 sinuses (83.5%). Compared to the standard X-ray, ultrasonography had a 95% sensitivity and a 98% specificity. In a study of patients with chronic nonpolypoid rhinosinusitis at 79 maxillary sinuses 10, the reliability of the A-mode ultrasonography in diagnosing chronic nonpolypoid diseases in maxillary sinuses was of a somewhat greater degree in comparison to roentgenography, amounting to 72% in relation to 61%.

The results of ultrasound were more heterogeneous than those of sinus radiography. The performers of sinus ultrasound scans were most often clinicians, not radiologists. In experienced hands, sinus ultrasound has similar accuracy as that of sinus radiography.

    References

    • Kuusela T, Kurri J, Sirola R. Ultraschall in der Sinusitis-Diagnostik bei Rekruten - Vergleich der Befunde der Punktion, Ultraschall- und Röntgenuntersuchung. Wehrmed Mschr Heft 1983;11:461-4.
    • Laine K, Määttä T, Varonen H, Mäkelä M. Diagnosing acute maxillary sinusitis in primary care: a comparison of ultrasound, clinical examination and radiography. Rhinology 1998 Mar;36(1):2-6. [PubMed]
    • Revonta M, Suonpää J, Luukkala M, Meriläinen P. Diagnostic ultrasound of maxillary and frontal sinusitis - a new simple echoscope and method. Acta Otolaryngol Suppl 1982; 386:265-7.
    • Savolainen S, Pietola M, Kiukaanniemi H, Lappalainen E, Salminen M, Mikkonen P. An ultrasound device in the diagnosis of acute maxillary sinusitis. Acta Otolaryngol Suppl 1997;529:148-52. [PubMed]
    • van Buchem L, Peeters M, Beaumont J, Knottnerus JA. Acute maxillary sinusitis in general practice: the relation between clinical picture and objective findings. Eur J Gen Pract 1995;1:155-60.
    • McNeill RA. Comparison of the findings on transillumination, x-ray and lavage of the maxillary sinus. J Laryngol Otol 1962:1009-13.
    • Varonen H, Mäkelä M, Savolainen S, Läärä E, Hilden J. Comparison of ultrasound, radiography, and clinical examination in the diagnosis of acute maxillary sinusitis: a systematic review. J Clin Epidemiol 2000 Sep;53(9):940-8. [PubMed]
    • Teppo H, Revonta M. Ultrasound device helps in ruling out maxillary sinus fluid in acute rhinosinusitis: how we do it. Clin Otolaryngol 2011;36(5):491-4. [PubMed]
    • Fufezan O, Asavoaie C, Chereches Panta P et al. The role of ultrasonography in the evaluation of maxillary sinusitis in pediatrics. Med Ultrason 2010;12(1):4-11. [PubMed]
    • Belic B, Erdevicki L, Stojanovic J et al. [A-mode ultrasonography and roentgenography in diagnosing chronic nonpolypoid maxillary rhinosinusitis]. Acta Chir Iugosl 2009;56(3):139-44. [PubMed]

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