Ep. 17: Compare tests that easily diagnose sinus infections
In my last podcast, I gave an overview of sinus cavities to provide a good foundation for understanding what physicians think about when people get sick. Be sure to check out my other episodes which share helpful tips about the best sinusitis treatments, complications of sinus infections and of course, surgical management for chronic sinus infections.
Today’s topic is will be a discussion about which tests are helpful to diagnose sinus infections.
The most common sinus problem is an infection or sinusitis. This occurs when inflammation occurs in the hollow sinus cavities, and fluid becomes trapped.
But when symptoms do not get better the way we expect, or they come back sooner than we expect, we may need to order some other tests. Each test adds a bit of information in a different way. And each test has a different reason for being ordered.
What are sinus infection symptoms?
To start with, when do we need to think that about sinus infections? Always remember, most infections are caused by viruses, even when the mucus is green! Check out my post that shares important information about nasal mucus and highlights why the color of mucus does not give us a diagnosis.
Acute sinus infections (less than 3 months) may have different symptoms than chronic ones (lasting over 3 months).
Most patients have several signs and symptoms at the same time. Others may have some symptoms that are off and on; most do not have all symptoms at once.
Some classic symptoms of acute sinus infections:
- stuffy nose
- pressure or pain in the sinuses, in the ears or in the teeth
- cloudy discolored nasal mucus
- facial tenderness
- sore throat
- bad breath
- reduced sense of smell and taste
- facial swelling
Chronic sinus infections often have 2 or more of the above symptoms for over 3 months, but fever is rare. Because of the longterm inflammation, may chronic sinus infection patients have chronic fatigue as well.
Methods to diagnose sinus infections
The best way for physicians to diagnose MOST medical problems is by recording an accurate medical history! This fact is one of the reasons I created blog posts to help patients understand what to expect from different levels of healthcare as well as visits with specialist physicians.
Everyone should jot down all of their symptoms that they have for their problem and not just share the ones they think are important. The history will always be the most important part of every interaction with physicians.
- Physicians perform an exam to understand the initial baseline
- Helps determine the urgency of the problem and may determine if tests are immediately needed
- A slight redness over the eye is very different from a puffy, nearly swollen shut eye
- Most sinus infections are diagnosed with examination alone
- Yes, this could be grouped as part of the physical exam, but it is an extra test that not everyone needs.
- Physicians, usually specialists, insert telescopes into the nose to get a more detailed exam
- Can be very useful to see pus or mucus dripping out of the sinus drainage pathway, swollen tissue blocking sinus drainage or another type of nasal blockage.
- Sometimes everything looks good, we might just observe a cold or treat for allergies
- Xrays are special types of electromagnetic radiation, most known for their ability to see through a person’s skin and show images of the bones beneath it.
- Hard materials, such as bones and teeth, are very good at absorbing xrays, but soft tissues, like skin and muscle, allow the xrays to pass straight through.
- Because there are many fancy types of xrays, “regular xrays” are sometimes called “plain xrays”.
- Sinus xrays can be just 1 view or 3 views, depending upon which sinus cavities that are being checked
- They might show bone is thinned or the sinus is changing shape because of pressure.
- This is NOT a typical sinus infection, so fancier tests are needed.
Computed tomography ( CT scan or CAT scan)
- This is a fancier xray!
- A CT scanner uses xrays and a computer to show more detailed images of the sinuses.
- Much better than plain xrays for diagnosing chronic sinus infections
- I often describe this process as lying on a table, and the head slides into a large donut.
- But nowadays, some ENT physicians have mini CT scanners in their offices where you sit still, and the machine moves around your head, much like it does at the dentist office.
- Many people worry about amounts of radiation when getting these tests.
- Xray machines over time have become faster and more efficient and less radiation is needed.
- However, as a society, we use many more xrays than we did in the past
- Over a longer period of time, radiation exposure can be significant, so there could be an increased risk of developing cancers.
- Check out this Harvard study, updated in 2018, which shares important radiation exposure facts.
- There is no need to fear any specific xray type as the amounts can be low, The concern is repeated xrays so that the amount accumulated becomes high.
- Important tip: Because patients are often treated by many different physicians, everyone may not know how many previous xrays have been ordered….so you might want to keep track of your xray history
- Also, DO NOT request xrays! Just like antibiotics, physicians may do it if you demand it, but there may be unintended consequences long term.
Magnetic resonance imaging ( MRI )
- Many people lump these radiology studies with xrays, but they are different.
- Instead of using radiation, these scan use magnets, and powerful radio waves to create detailed pictures of the body
- I like to think about these scans as almost opposite of CT scans and xrays.
- Xrays show bone and teeth really well, but soft tissue and fluid are not seen as nicely
- MRI scans very clearly show differences between soft tissues, like blood looks different than mucus or a tumor.
- The bone is not well seen on these scans
- Many ENT physicians don’t really like this study for routine sinus problems because seeing the boney outline is important.
- If there is something unusual on xrays, then the MRI gives additional information
- I quite often get referred kids who have chronic headaches and have had an MRI of the brain.
- It is highly sensitive because things in the brain are not supposed to be inflamed, while sinus infections, allergies, and colds cause inflammation of the sinuses regularly.
- The scan can look like a severe nose and ear problem instead of common inflammation
- When the patients come, if there is not a history of infections or the exam that is not significant, I may monitor or treat for basic allergies
- Sometimes the scan shows something that is concerning for sinus problems, so I may order a CT scan
Hope I was able to share an interesting bit of information, something that maybe you did not know before. I love it when at least one person learns something. Was that you?
As always, much love for supporting my work. I will be adding many more posts to highlight parenting and healthcare tips, so be sure to consider subscribing to my podcast or to my blog to avoid missing a post!