Diagnosis of rhinosinusitis

Medical history. Patients with symptoms of acute rhinosinusitis will be asked questions and their case history recorded (anamnesis) and, if possible, a nasal endoscopy. Imaging tests are only carried out in patients where the diagnosis is unclear or who present a slow evolution. In patients suspected of chronic rhinosinusitis, besides the interview, they will also undergo a nasal endoscopy and imaging tests.

Nasal endoscopy. A rigid or flexible endoscope with a fibre optic light is inserted in the patient’s nose to obtain a view of the nasal cavity. 

Imaging tests. Images obtained from a computed tomography or magnetic resonance imaging study (in fact of complications) can reveal details about the paranasal sinuses and nasal area. These images can help produce an accurate view of deep inflammation or a physical obstruction that is hard to identify with an endoscope. It has recently been demonstrated that X-rays of the paranasal sinuses are completely unnecessary for the diagnosis of rhinosinusitis (both acute or chronic).

Olfactometry or gustometry. Allows an assessment of the sense of smell and taste.

Nasal cultures. In general, cultures are not required for the diagnosis of chronic rhinosinusitis. Nevertheless, if the condition does not respond to treatment or worsens, tissue cultures can help determine the cause, e.g., whether bacterial or fungal.

Allergy test. If the doctor suspects that the condition may be caused by an allergy, a skin allergy test may be recommended. Skin tests are safe and quick and can help accurately identify the allergen responsible for nasal discomfort. In some cases, a blood test may be ordered to broaden the allergy study and determine the specific antibodies against the allergens.