Ultrasonographic bedside evaluation of maxillary sinus disease in mechanically ventilated patients.

OBJECTIVE: Evaluate A-mode ultrasonographic examination of maxillary sinus disease in mechanically ventilated, critically ill patients using sinoscopy as criterion standard.
DESIGN: Prospective case series.
SETTING: The intensive care units of a tertiary care hospital. PATIENTS: 25 mechanically ventilated, critically ill patients with nasotracheal intubation or a tracheotomy were followed up by ultrasonographic examination of the maxillary sinuses in supine and semirecumbent positions. Infectious sinusitis was suspected in 15 patients, who were bilaterally sinoscoped combined with sampling for bacterial culture.
RESULTS: The frequency of oedema and/or secretions was high: 29 antra of 30 examined. Only 2 of 30 antra showed bacterial infection. Ultrasonographic examinations were sensitive to general pathological changes but less accurate in specific diagnostics such as the presence of secretions (sensitivity for fluid 75%, oedema 81%). The sensitivity of ultrasonographic diagnosis improved when the examination was made in the semirecumbent position (sensitivity for fluid 91%, oedema 81%).
CONCLUSIONS: A-mode ultrasonography is a useful method for daily use, being easy to perform and without discomfort to the patient. It is fast and gives an immediate diagnosis. In intensive care unit patients, it should be the method of choice for day-to-day studies of effects and changes in the upper airways. For the differential diagnosis of oedema and/or secretions, it is not reliable enough to be used as the sole diagnostic method. A complementary investigation, such as computed tomography or sinoscopy, which also provides the opportunity to take samples, is needed for diagnostic confidence.