Usefulness of subjective symptoms and imaging findings in the diagnosis of unilateral sinus disease

Diagnosis and treatment decisions are often difficult in cases where sinus CT reveals unilateral sinus shadows, because the differential diagnosis would include not only chronic sinusitis, but also other diverse diseases, including fungal paranasal sinusitis, odontogenic maxillary sinusitis and paranasal sinus tumor. For a precise diagnosis of unilateral sinus disease, we considered the usefulness of subjective symptoms, condition of the nasal mass, CT findings and MRI findings, and also examined the proper use of MRI. We reviewed 151 cases of unilateral paranasal sinus disease seen from January 2012 to December 2017 at Keiyu Hospital. We found that subjective symptoms were not useful for differential diagnosis, because the symptoms were mostly non-specific. Presence of a nasal mass suggested a high possibility of chronic sinusitis with a polyp or tumor, and a biopsy was useful for the diagnosis, but it must be borne in mind that some malignant tumors do not present with a nasal mass. CT showed bone destruction only in malignant tumors, while calcification was observed only in cases of fungal paranasal sinusitis, both of which findings were useful for the differential diagnosis. Lund-Mackey scores were significantly lower in acute sinusitis, which may also help in the differential diagnosis. Dental findings(periapical pathosis and tooth extraction)in the maxillary sinus and an open middle meatus, which suggests good ventilation, suggest maxillary sinusitis. MRI was often used excessively in our patients.