Search tips
Search criteria 


Logo of bmjThe BMJ
BMJ. 1992 September 19; 305(6855): 684–687.
PMCID: PMC1882971

Use of symptoms and signs to diagnose maxillary sinusitis in general practice: comparison with ultrasonography.


OBJECTIVE--To establish the incidence of maxillary sinusitis in general practice and the predictive value of symptoms and signs. DESIGN--Population based study. SETTING--9 general practices with 15,220 patients aged 15 years and older on the list. PATIENTS--400 patients with 441 episodes in whom practitioners intended to confirm or to exclude sinusitis. MAIN OUTCOME MEASURES--Results of ultrasonography and signs and symptoms associated with positive results. RESULTS--212 of the 441 episodes were confirmed by ultrasonography. 15.7 episodes occurred per 1000 adults per year. The five symptoms beginning with common cold (beta coefficient = 1.035), purulent rhinorrhoea (0.996), pain at bending (0.950), unilateral maxillary pain (0.640), and pain in teeth (0.606) were associated with positive results on ultrasonography. General practitioners' clinical diagnoses were correct in 177 episodes, false positive in 88, false negative in 22, and uncertain in 154. With an algorithm using the five weighted symptoms 243 of the diagnoses would have been correct, but 110 would remain uncertain and 44 cases would have been missed. CONCLUSION--The five symptoms algorithm would improve diagnostic accuracy of general practitioners, but incorrect and uncertain diagnoses cannot be avoided.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (948K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Axelsson A, Chidekel N. Symptomatology and bacteriology correlated to radiological findings in acute maxillary sinusitis. Acta Otolaryngol. 1972 Jul-Aug;74(1):118–122. [PubMed]
  • Axelsson A, Runze U. Symptoms and signs of acute maxillary sinusitis. ORL J Otorhinolaryngol Relat Spec. 1976;38(5):298–308. [PubMed]
  • Axelsson A, Runze U. Comparison of subjective and radiological findings during the course of acute maxillary sinusitis. Ann Otol Rhinol Laryngol. 1983 Jan-Feb;92(1 Pt 1):75–77. [PubMed]
  • Berg O, Bergstedt H, Carenfelt C, Lind MG, Perols O. Discrimination of purulent from nonpurulent maxillary sinusitis. Clinical and radiographic diagnosis. Ann Otol Rhinol Laryngol. 1981 May-Jun;90(3 Pt 1):272–275. [PubMed]
  • Berg O, Carenfelt C. Analysis of symptoms and clinical signs in the maxillary sinus empyema. Acta Otolaryngol. 1988 Mar-Apr;105(3-4):343–349. [PubMed]
  • Bauer WJ, Bockmeyer M, Mang WL. Endoskopisch kontrollierte Ultraschalldiagnostik der Kieferhöhlen. Laryngol Rhinol Otol (Stuttg) 1983 Oct;62(10):443–445. [PubMed]
  • Otten FW, Bouwhuis-Hoogerwerf ML, Grote JJ. Echografie als onderzoekmethode van de sinus maxillaris. Ned Tijdschr Geneeskd. 1984 Oct 13;128(41):1941–1944. [PubMed]
  • VUORINEN P, KAUPPILA A, PULKKINEN K. Comparison of of results of roentgen examination and puncture and irrigation of the maxillary sinuses. J Laryngol Otol. 1962 May;76:359–364. [PubMed]
  • Illum P, Jeppesen F, Langebaek E. X-ray examination and sinoscopy in maxillary sinus disease. Acta Otolaryngol. 1972 Oct;74(4):287–292. [PubMed]
  • Otten FW, Engberts GE, Grote JJ. Ultrasonography as a method of examination of the frontal sinus. Clin Otolaryngol Allied Sci. 1991 Jun;16(3):285–287. [PubMed]
  • Suonpä J, Revonta M. Diagnosis of frontal sinusitis: one-dimensional ultrasonography versus radiography. J Laryngol Otol. 1989 Aug;103(8):765–767. [PubMed]
  • Davidson TM, Brahme FJ, Gallagher ME. Radiographic evaluation for nasal dysfunction: computed tomography versus plain films. Head Neck. 1989 Sep-Oct;11(5):405–409. [PubMed]
  • Lloyd GA, Lund VJ, Scadding GK. CT of the paranasal sinuses and functional endoscopic surgery: a critical analysis of 100 symptomatic patients. J Laryngol Otol. 1991 Mar;105(3):181–185. [PubMed]
  • Vainio-Mattila J. Correlations of nasal symptoms and signs in random sampling study. Acta Otolaryngol Suppl. 1974;318:1–48. [PubMed]
  • Savolainen S. Allergy in patients with acute maxillary sinusitis. Allergy. 1989 Feb;44(2):116–122. [PubMed]
  • Ylikoski J, Savolainen S, Jousimies-Somer H. The bacteriology of acute maxillary sinusitis. ORL J Otorhinolaryngol Relat Spec. 1989;51(3):175–181. [PubMed]

Articles from The BMJ are provided here courtesy of BMJ Publishing Group