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
Nose and paranasal sinuses. In: Netter’s Radiologic Anatomy Presenter.
Bottom line: Also known as postanginal sepsis, Lemierre syndrome is a rare sequelae to an otolaryngological infection, such as pharyngitis, otitis media or peritonsillar abscess. The infection spreads to the internal jugular vein, causing septic thrombophlebitis and septicemia.
Summary: Vargiami EG, Zafeiriou DI. Eponym: The Lemierre syndrome. Eur J Pediatr (2010) 169:411–414.
Most often affects otherwise healthy adolescents and young adults although may also affect other age groups. Organism frequently associated with Lemierre syndrome is F. necrophorum, an anaerobic organism that lives in the oropharynx, although in many case reports describe polymicrobial bacteremia. Clinical presentation includes inflammation of the pharynx, rise of temperature, neck swelling and pain beginning about 1-2 weeks after onset of a sore throat. Complications include pulmonary abscesses, osteomyelitis, skin abscesses, hepatomegaly and splenomegaly, cerebral abscesses, pericarditis, endocarditis, and thrombocytopenia and disseminated intravascular coagulation.
See DDX for oral ulcers in AccessMedicine
See DDx for Leukoplakia at AccessMedicine
See examples of acute closed-angle glaucoma in AccessMedicine and MDConsult. According to Physical Section of Glaucoma topic in DynaMed, and Glaucoma, Acute Angle-Closure topic in AccessMedicine, findings include
moderately dilated pupil
elevated intraocular pressure (according to AccessMedicine, > 50 mm Hg, producing hard eye on palpation)
shallow anterior chamber
closed angle by gonioscopy
Other clinical findings can include severe ocular pain, blurred vision, halos around lights, nausea, vomiting
Bottom line: Used to localize loss of hearing perception and conduction by applying vibrating fork to midline of patient’s skull.
See Fig. 7-16A for visual of where to place vibrating fork. -The Head and Neck. In: DeGowin’s Diagnostic Examination. (AccessMedicine.)
Weber Test (Wikipedia) includes a table that summarizes how the findings of the Weber and Rinne tests can be used to screen patients for sensorineural versus conductive loss and localized left or right.
Bates guide has a short video showing how to conduct Weber test. It starts about ¾ of the way through the Examining the Ears video.