The Management of Sinusitis Through Imaging

Woman with Sinusitis

By Stephen Chandler, MD |26 May 2021|

Sinusitis is the fifth most common diagnosis requiring antibiotics, and one of the most common conditions brought to primary care physicians. Viral sinusitis is typically not a serious condition and can be treated through the use of nasal rinsing devices or medication — usually over the counter. However, complications with this condition can become serious and symptoms dramatically worsen if the viral process evolves into a bacterial infection. Updates in radiologic imaging have led to an increase in the understanding and treatment of sinusitis. Technology has evolved well beyond Plain radiography. Computed Tomography (CT scans) and Magnetic Resonance Imaging (MRI scans) provide doctors the extremely detailed anatomic information required to localize otherwise hidden reasons for progressive and chronic symptoms.

Though not used in surgical planning, Plain Radiography has a limited role in the diagnosis of sinusitis. To put it simply, Plain Radiographs are X-rays that can be used to detect mucosal thickening and air fluid levels. However, generally speaking, Plain Radiographs provide limited resolution capability and relatively poor visualization of sinus anatomy. This type of imaging should only be used as a screening modality for patients with progressing symptoms after treatment. 

CT scans can provide a highly detailed image of the sinuses, in contrast with plain radiography. The exquisite detail of CT imaging is much more useful in detecting sinus pathology, anatomic variation contributing to recurrent sinus disease and provides the roadmap for the surgical treatment of sinus disease.

MRIs allow for better definition of the soft tissue within the sinuses; however, this modality provides no real advantages over CT imaging, except in the evaluation of possible sinus tumors, blood vessel anomalies or central nervous system disorders. 

Our understanding and management of sinusitis has improved since the introduction of plain radiography, CT scans, and MRI. Relatively mild symptoms and uncomplicated cases of sinusitis are most often treated by primary care physicians based on empirical findings. However, recurrent or persistent symptoms may require further more detailed evaluation. 

Dr. Stephen Chandler is a practicing Otolaryngologist in Montgomery, Alabama and owner of Sandler Scientific, LLC, makers of CompleteRinse®. To schedule a visit with Dr. Chandler call 334-834-7221 Learn more at Complete Rinse is available on Amazon and at