October 04, 2010

Sinus X-Rays Are Worthless

Oftentimes, I see patients come in with sinus x-rays with this or that finding. What many patients as well as physicians may not realize is that sinus x-rays are notoriously unreliable in determining whether sinus infection is present or not. Indeed, I NEVER order a sinus x-ray. Just how unreliable are sinus x-rays?

In adults, it may be literally a flip of the coin whether the sinus x-ray is providing a correct diagnosis compared with the gold standard CT sinus.

Depending on what study you look at, the specificity of a sinus x-ray hovers around 50% (how often it correctly states normal sinuses). Sensitivity is a little better at around 80% (how often it correctly detects actual sinusitis).

Several studies have concluded that sinus plain film x-rays are unreliable and no longer routinely indicated for the evaluation of nasal and paranasal sinus disease. When radiographic evaluation is indicated a limited CT series provides superior information.

Take home message?

Do not order a sinus x-ray when evaluating for sinus disease/sinusitis!!! Why bother ordering a test that is going to be wrong almost half the time?

(If a CT sinus comes back normal, the patient most definitely does NOT have acute or chronic sinusitis.)

Interestingly, sinus x-rays in kids (2+ years old) may be more reliable and in this sub-population, may be beneficial [Link]. But this study unfortunately did not include CT sinus scans to verify sinus x-ray findings. It should also be noted that sinus x-rays younger than 2 years old is also unreliable [Link].

Radiographic evaluation for nasal dysfunction: computed tomography versus plain films. Head Neck. 11 (5), 405-9. 1989

Comparison of sinus x-rays with computed tomography scans in acute sinusitis. Acad Emerg Med. 1 (3), 235-9. 1994

Sinusitis and chronic cough in children. J Asthma Allergy 5:27-32. 2012.

Maxillary sinus radiographs in children with nonrespiratory complaints. Pediatrics. 1984;73(3):306–308.

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.


Anonymous said...

How about the much greater radiation that a CT scan exposes you too (versus a plain x-ray)? The risk of cancer should be considered too when ordering these tests.

Anonymous said...

It seems a lot of Doctors are not trained in radiation protection and therefore do not consider radiation exposures to patients. As an xray tech, I have seen many exams move away from plain film to CT and it is true that CT is almost always superior to plain film xrays. However, there has been an increase in Thyroid cancers and you have to wonder whether there is a correlation. It is a fact that the general population receives the majority of their radiation exposure through medical procedures.

Anonymous said...

Would the same apply to a pre-teen or elementary school-aged patient? Or would it be safer to do the plain x-ray?

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