Acute bacterial sinusitis is diagnosed when two or more of the following last longer than ten days, or get worse after seven days:
- Thick or discolored nasal discharge
- Nasal congestion or obstruction
- Facial pain, pressure or fullness
- Decreased sense of smell
Chronic sinusitis is diagnosed when two or more of the previous symptoms have lasted longer than 3 months, and there is at least one of the following to confirm sinus inflammation:
- Pus draining from the sinuses
- Polyps in the nose or sinuses
- Swelling or fluid in the sinuses on CT
At Richmond ENT, we take pride in performing a complete medical history on the first visit, so that we can provide an integrated approach to ear, nose and throat disorders. We strongly recommend that you use our secure web portal to ensure a complete and accurate history and to allow us to securely contact you with test results and follow-up appointments.
A complete ENT examination includes inspection of the face, ears, nose, throat and neck. The specialty nasal examination is performed with a headlight or mirror and a handheld speculum that allows us to examine the nasal septum and turbinates closely. Your nose will often be examined before and after application of a decongestant nose spray. A unique part of the ENT visit is an examination of the back of the nose using hand-held mirrors in the mouth. These special skills and tools allow the ear, nose and throat physician to obtain a better examination of the entire length of the nasal passages.
Nasal endoscopy is commonly performed in patients with nasal, sinus, or allergy complaints. The nurse will spray your nose with a decongestant combined with lidocaine, a local anesthetic. The physician or nurse practitioner will then pass a small telescope into each nostril to obtain a magnified view. We can readily identify abnormal swelling, enlarged turbinates, nasal polyps, septal deformities, and sinus drainage. We are generally well equipped to culture abnormal secretions or to biopsy abnormal findings. In most cases, we have the opportunity to display the endoscopic image on a television monitor, so that you can better understand your condition.
Our Xoran MiniCAT CT scanner allows us to see the detailed anatomy and contents of all the sinuses. Richmond ENT is the first medical practice in central Virginia to offer the immediate availability of a 20 second CT scan in our own office, saving you a separate trip to a radiology center and then a second visit with us to discuss the results. The test is commonly used to document chronic sinusitis and to evaluate the potential benefit of Balloon Sinuplasty or endoscopic sinus surgery. Our open access, special use scanner exposes you to 80-90% less radiation than full-size scanners at a hospital.
Sinus cultures are useful for identifying resistant bacteria if initial antibiotic treatment fails. Random swabs of the nose are rarely useful, as the nose is never sterile. Better cultures are taken when pus is seen draining directly from the sinus during nasal endoscopy. The endoscopic observation of pus confirms the diagnosis of sinusitis and allows the specialist to place a small swab directly into the abnormal mucous. Culture specimens are sent to a reference laboratory and results may take up to 1 week. Should you fail to hear from us within 7 days, please call the office at 804-622-3782.
The biggest limitation of traditional culture methods is that some bacteria grow better in the body than they do on a Petri dish. A negative culture simply means that no particular bacteria grew from the sample in the laboratory. Using DNA analysis similar to that used by crime scene investigators, we can now identify if any bacteria were recently in the nose by recognizing traces of DNA. Results for the most common bacteria are reported within 48 hours, and extensive results are provided in 7 days. The current concern about this technology is the extreme sensitivity – we do not know enough about the test to be sure that the presence of these DNA strands actually represents disease.
Allergy testing is commonly recommended for patients with chronic or recurrent acute sinusitis. Allergies may contribute to nasal swelling and sinus blockage. Patients who require sinus surgery have greater improvement if their allergies are treated at the same time.
Immune Function Testing
Immunologic deficiencies are uncommon, but can contribute to chronic sinusitis. Basic testing may include a complete blood count and serum immunoglobulin levels. Testing the response to vaccines can demonstrate the ability to produce specific antibodies. Sweat chloride testing is used to evaluate for cystic fibrosis. HIV has also been shown to cause increased incidence and severity of sinusitis.,
Costs of diagnostic tests
The co-payment for an office visit applies to the ENT history and examination, but does not include any of the additional diagnostic tests listed above. These tests are billed separately to your insurance company and you will likely be responsible for a portion or all of these charges.
 Armstrong M, McArthur JC, Zinreich SJ: Radiographic imaging of sinusitis in HIV infection. Otolaryngol Head Neck Surg, 108:36-43, 1993.
 Godofsky EW, Zinreich SJ, Armstrong M, Leslie J, Weikel CS: Sinusitis in HIV-infected patients: A clinical and radiographic review. Am. J. Med. 93:163-170, 1992.