Bottom line: There is no evidence that transillumination as a single finding is sensitive or specific enough to diagnose acute sinusitis, but when considered in combination with other findings, it can be useful in establishing a diagnosis.
Summary: Williams JW, et al. Does this patient have sinusitis? JAMAEvidence.
This systematic review of evidence on diagnosis of sinusitis revealed that most studies of transillumination (see Fig. 45-5 for image) had methodological limitations. Two higher quality studies had contradictory findings. One study of 248 patients in primary care walk in clinic found that a normal transillumination of maxillary sinuses had LR of 0.5 and dull or opaque sinuses had a LR of 1.6. The other study of 113 patients in otolaryngology clinic found that transillumination showing normal sinuses had LR of 0.04 and a high LR when the sinuses were completely opaque, but less helpful LR of 0.41 when sinuses were partially opaque.
There was evidence that the findings from transillumination, when combined with other clinical findings, such as maxillary toothache or prurulent discharge, could be useful in diagnosing sinusitis. Tables 45-3 and 45-4 show that when at least 4 of the following findings are present, the positive LR of sinusitis is 6.4:
- maxillary toothache
- prurulent discharge
- lack of response to decongestants
- abnormal transillumination
- colored nasal discharge