Laboratory or radiologic tests may be of limited value in the diagnosis of acute rhinosinusitis (ARS). Normal radiography may help rule out sinusitis when negative, whereas CRP and ESR may help rule in sinusitis when positive, but they cannot be routinely recommended.
A systematic review 1 identified a total of 30 studies, 16 enrolling adults, eight both adults and children, four enrolling only children and two that did not report the age of participants. Two were retrospective cohort studies, and the remainder were prospective cohort studies. Two studies enrolled patients with the common cold or a ‘runny nose', while the remaining 28 enrolled patients with clinically suspected acute sinusitis.
Using antral puncture as the reference standard, A mode ultrasound (positive likelihood ratio [LR+] 1.71, negative likelihood ratio [LR-] 0.41), B mode ultrasound (LR+ 1.64, LR- 0.69), and radiography (LR+ 2.01, LR- 0.28) had only modest accuracy. Accuracy was higher using imaging as the reference standard for both ultrasound (LR+12.4, LR- 0.35) and radiography (LR+ 9.4, LR- 0.27), although this likely overestimates accuracy. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) both had clear threshold effects, and modest overall accuracy. The LR+ for ESR >30 and >40 were 4.08 and 7.40, respectively. A dipstick of nasal secretions for leucocyte esterase was highly accurate (LR+ 18.4, LR- 0.17) but has not been validated.
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