URTIS AND SINUS PROBLEMS: DIAGNOSING SINUS TENDERNESS
Eliciting sinus tenderness is important in the diagnosis and follow-up of sinusitis.
Firm pressure over any facial bone, particularly in the patient with an upper respiratory infection, may cause pain. It is important to differentiate sinus tenderness from non-sinus bone tenderness.
This is best done by palpating a non-sinus area first and last (Fig. 13.1), systematically exerting pressure over the temporal bones (T), then the frontal (F), ethmoid (E) and maxillary (M) sinuses, and finally zygomas (Z), or vice versa.
Differential tenderness both identifies and localises the main sites of infection.
T (temporal) and Z (zygoma) represent no sinus bony tenderness, for purposes of comparison (F = frontal sinuses; E = ethmoid sinuses; M = maxillary sinuses)
DIAGNOSIS OF UNILATERAL SINUSITIS
A simple way to assess the presence or absence of fluid in the frontal sinus, and in the maxillary sinus (in particular), is the use of transillumination. It works best when one symptomatic side can be compared with an asymptomatic side.
It is necessary to have the patient in a darkened room and to use a small, narrow-beam torch.
Shine the torch above the eye in the roof of the orbit (touching the skin under the eyebrow) and also directly over the frontal sinuses, and compare the illuminations.
Remove dentures (if any). Shine the light inside the mouth (touching the mucosa), on either side of the hard palate, pointed at the base of the orbit. A dull glow seen below the orbit indicates that the antrum is air-filled. Diminished illumination on the symptomatic side indicates sinusitis.
Unblocking maxillary sinuses
Particularly in light of recommendations against antibiotics in most cases of sinusitis, a ‘hydrate and vibrate’ approach to clearing the mucus is worth trying.
Squirt 8 sprays of saline into the nostril on the affected side (bilaterally if indicated). Position an electric toothbrush against the upper molars and vibrate for up to five minutes. Blow and clear the nose, using further saline sprays as necessary.
Simple inhalations for upper respiratory tract infections (including upper airways obstruction from the oedema and secretions of rhinitis and sinusitis) can promote symptomatic relief and early resolution of the problem. The positive effect of making the patient responsible for active participation in management often helps to counterbalance the occasional disappointment when no antibiotic is prescribed.
The old method of towel over the head and inhalation bowl can be used, but it is better to direct the vapour at the nose.