Editing Sinusitis (section)

==Diagnosis==
===Classification===
[[File:Otorhinolaryngology - Sinusitis -- Smart-Servier.png|thumb|upright=0.9|Illustration depicting sinusitis, note the fluid in the sini]]

Sinusitis (or rhinosinusitis) is defined as an inflammation of the [[nasal mucosa|mucous membrane]] that lines the [[paranasal sinuses]] and is classified chronologically into several categories:<ref name="Radojicic">{{cite web |url=http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/allergy/rhino-sinusitis/ |publisher=[[Cleveland Clinic]] | first = Christine | last = Radojicic |title=Sinusitis |work=Disease Management Project |access-date=November 26, 2012 |url-status=live |archive-url=https://web.archive.org/web/20121114060719/http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/allergy/rhino-sinusitis/ |archive-date=November 14, 2012 }}</ref>
* [[Acute (medicine)|Acute]] sinusitis – A new infection that may last up to four weeks and can be subdivided symptomatically into severe and nonsevere. Some use definitions up to 12 weeks.<ref name="pmid25833927">{{cite journal |vauthors=Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, Orlandi RR, Palmer JN, Patel ZM, Peters A, Walsh SA, Corrigan MD |date=April 2015 |title=Clinical practice guideline (update): Adult Sinusitis Executive Summary |journal=Otolaryngology–Head and Neck Surgery |volume=152 |issue=4 |pages=598–609 |doi=10.1177/0194599815574247 |pmid=25833927 |s2cid=206469424 |doi-access=free}}</ref>
* Recurrent acute sinusitis – Four or more full episodes of acute sinusitis that occur within one year
* [[Subacute]] sinusitis – An infection that lasts between four and 12 weeks, and represents a transition between acute and chronic infection.
* [[Chronic (medicine)|Chronic]] sinusitis – When the signs and symptoms last for more than 12 weeks.<ref name="pmid25833927"/>
* Acute exacerbation of chronic sinusitis – When the signs and symptoms of chronic sinusitis exacerbate, but return to baseline after treatment.

Roughly 90% of adults have had sinusitis at some point in their lives.<ref>{{cite journal | vauthors = Pearlman AN, Conley DB | title = Review of current guidelines related to the diagnosis and treatment of rhinosinusitis | journal = Current Opinion in Otolaryngology & Head and Neck Surgery | volume = 16 | issue = 3 | pages = 226–30 | date = June 2008 | pmid = 18475076 | doi = 10.1097/MOO.0b013e3282fdcc9a | s2cid = 23638755 }}</ref>

===Acute===
Health care providers distinguish bacterial and viral sinusitis by [[watchful waiting]].<ref name="pmid25833927"/> If a person has had sinusitis for fewer than 10 days without the symptoms becoming worse, then the infection is presumed to be viral.<ref name="pmid25833927"/> When symptoms last more than 10 days or get worse in that time, then the infection is considered bacterial sinusitis.<ref name="pmid17761281"/> Pain in the teeth and bad breath are also more indicative of bacterial disease.<ref>{{cite journal | vauthors = Ebell MH, McKay B, Dale A, Guilbault R, Ermias Y | title = Accuracy of Signs and Symptoms for the Diagnosis of Acute Rhinosinusitis and Acute Bacterial Rhinosinusitis | journal = Annals of Family Medicine | volume = 17 | issue = 2 | pages = 164–172 | date = March 2019 | pmid = 30858261 | pmc = 6411403 | doi = 10.1370/afm.2354 }}</ref>

Imaging by either X-ray, CT or MRI is generally not recommended unless complications develop.<ref name="pmid17761281">{{cite journal | vauthors = Rosenfeld RM, Andes D, Bhattacharyya N, Cheung D, Eisenberg S, Ganiats TG, Gelzer A, Hamilos D, Haydon RC, Hudgins PA, Jones S, Krouse HJ, Lee LH, Mahoney MC, Marple BF, Mitchell CJ, Nathan R, Shiffman RN, Smith TL, Witsell DL | title = Clinical practice guideline: adult sinusitis | journal = Otolaryngology–Head and Neck Surgery | volume = 137 | issue = 3 Suppl | pages = S1-31 | date = September 2007 | pmid = 17761281 | doi = 10.1016/j.otohns.2007.06.726 | s2cid = 16593182 | doi-access = free }}</ref> Pain caused by sinusitis is sometimes confused for pain caused by [[pulpitis]] (toothache) of the maxillary teeth, and vice versa. Classically, the increased pain when tilting the head forwards separates sinusitis from [[pulpitis]].<ref>{{Cite web |title=Sinus infection and toothache: Any connection? |url=https://www.mayoclinic.org/diseases-conditions/acute-sinusitis/expert-answers/toothache/faq-20058299 |access-date=2025-03-18 |website=Mayo Clinic |language=en}}</ref>

For cases of maxillary sinusitis, limited field [[Cone beam computed tomography|CBCT]] imaging, as compared to [[periapical]] [[radiograph]]s, improves the ability to detect the teeth as the sources for sinusitis. A coronal CT picture may also be useful.<ref name="American Association of Endodontists-2018"/>

===Chronic===
For sinusitis lasting more than 12 weeks, a [[CT scan]] is recommended.<ref name="pmid17761281" /> On a CT scan, acute sinus secretions have a [[radiodensity]] of 10 to 25 [[Hounsfield unit]]s (HU), but in a more chronic state they become more [[Viscosity|viscous]], with a radiodensity of 30 to 60 HU.<ref>[https://books.google.com/books?id=FxUgUBVBmUUC&pg=PA674 Page 674] {{webarchive|url=https://web.archive.org/web/20170216044325/https://books.google.com/books?id=FxUgUBVBmUUC&pg=PA674 |date=2017-02-16 }} in: {{cite book|title=Cummings Otolaryngology – Head and Neck Surgery, 3-Volume Set| vauthors = Flint PW, Haughey BH, Niparko JK, Richardson MA, Lund VJ, Robbins KT, Lesperance MM, Thomas JR | author-link3 = John Niparko |publisher=Elsevier Health Sciences|year=2010|isbn=9780323080873}}</ref>

Nasal [[endoscopy]] and clinical symptoms are also used to make a positive diagnosis.<ref name="pmid18206715"/> A tissue sample for [[histology]] and [[cultures]] can also be collected and tested.<ref>Harrison's Manual of Medicine 16/e</ref> Nasal endoscopy involves inserting a flexible [[fiber-optic]] tube with a light and camera at its tip into the nose to examine the nasal passages and sinuses.

Sinus infections, if they result in tooth pain, usually present with pain involving more than one of the upper teeth, whereas a toothache usually involves a single tooth. Dental examination and appropriate radiography aid in ruling out pain arises from a tooth.<ref name="Burket-2014">{{cite book|title=Burket's oral medicine|publisher=Burket's oral medicine|last=Glick|first=Michael|date=30 June 2014 |isbn=978-1-60795-280-0|edition=12th|location=Shelton, Connecticut|pages=341|oclc=903962852}}</ref>

<gallery mode="packed" widths="360px" heights="220">
Image:Sinuses and Sinusitis (5937085231).jpg|CT of chronic sinusitis
File:CT of chronic sinuitis.jpg|[[CT scan]] of chronic sinusitis, showing a filled right maxillary sinus with sclerotic thickened bone
File:Brain MRI 112010 rgbca.png|MRI image showing sinusitis. Edema and mucosal thickening appears in both maxillary sinuses.
File:RtmaxobitinfectteethCT.png|Maxillary sinusitis caused by a dental infection associated with [[periorbital cellulitis]]
File:FrontalSinusitisMark.png|Frontal sinusitis
File:Maxilar sinusites.jpg|[[Projectional radiography|X-ray]] of left-sided maxillary sinusitis marked by an arrow. There is lack of the air transparency indicating fluid in contrast to the other side.
</gallery>