We write to inform you of the results of our recent audit relating to imaging in cases of suspected chronic sinusitis.
All facial X-ray requests over a 6-month period at Hope Hospital, Salford, were audited. We found that 54 plain X-rays were performed in cases of suspected sinusitis. Of these, 34 were reported as normal, 16 were abnormal and four were unavailable for review. Forty patients were subsequently referred for further ENT review. We found no correlation between X-ray findings, incidence of referral and eventual treatment. Of 54 plain X-ray requests, 50 originated from primary care (either family GP or emergency hospital GP), three requests were from Accident and Emergency and one was from a non-ENT outpatient clinic.
Examination of the current guidelines and evidence regarding appropriate imaging in suspected sinusitis suggests that this current practice is now outdated. Guidelines from the Royal College of Radiologists discourage the use of plain facial X-rays in suspected cases of sinusitis. Plain X-rays have been shown to have low sensitivity and specificity for sinusitis and expose patients to unnecessary radiation. Imaging is generally indicated in chronic sinusitis if operative intervention is being considered and in these cases computerised tomography will define preoperative anatomy and in addition has high diagnostic sensitivity.
In conclusion, chronic sinusitis is a clinical diagnosis in which plain X-rays are diagnostically unhelpful.
- © British Journal of General Practice, 2006.