ABSTRACT
This chapter discusses the relevant anatomy and pathophysiology of sinusitis, its clinical features, diagnostic testing, and treatment and then describes sphenoidal sinusitis and nasal headache. Acute sinusitis is usually characterized by purulent discharge in the nasal passages and a pain profile determined by the site of infection. The paranasal sinuses are air-filled cavities that connect with the nasal airway. They are lined with pseudostratified-ciliated epithelial tissue, which is covered by a thin layer of mucus. Standard X-ray is inadequate for the clinical evaluation of sinusitis because it does not evaluate the anterior ethmoid air cells, the upper two-thirds of the nasal cavity, or the infundibular, middle meatus, or frontal recess air pas-sages. Computed tomography (CT) is the optimal radiographic study to assess the paranasal sinuses for evidence of disease. Endoscopy should be considered when a sinus-related problem is suspected in a patient for whom conservative medical treatment fails and whose CT or magnetic resonance imaging (MRI) is inconclusive.
