Diagnosis

The diagnosis is clinical in most patients. Five clinical findings

have been shown to be highly predictive of sinusitis:

• Maxillary toothache.

• Patient report of colored nasal discharge.

• Mucopurulent discharge on examination.

• Poor response to decongestants.

• Inability to transilluminate the sinus.

The incidence of sinusitis is around 92 percent when all five features are present versus only nine percent when none are present. Most patients would be somewhere between these extremes. In this setting, there may be sufficient suspicion of sinusitis to merit the use of antibiotics when two or more of these findings are present without the need for sinus radiographs