Palpation is a diagnostic technique using the hands or fingers to feel various parts of the body during a physical assessment. In the context of the face, this involves light touching to evaluate underlying structures. The primary goal of sinus palpation is to check for tenderness, a common indicator of inflammation or infection within the air-filled cavities. Tenderness suggests the mucosal lining of the sinuses is swollen, causing pressure against the surrounding bony walls.
Preparation and Positioning for Assessment
The person should be seated upright with their head in a neutral position, which helps relax facial muscles and allows easier access to the sinus areas. The examiner should wash their hands thoroughly before touching the patient’s face to maintain hygiene standards. The technique requires applying gentle, controlled pressure using the pads of the fingers or thumbs, not the sharp tips or nails. Light palpation is the appropriate method, involving pressure of about one to two centimeters to identify tenderness.
Palpation Technique for Major Sinuses
The two sinus pairs most accessible for physical palpation are the frontal and the maxillary sinuses. Palpating these areas requires a sequential, gentle approach to assess for localized pain or swelling. Tenderness found in these specific locations points toward possible pathology within the corresponding sinus cavity.
Frontal Sinuses
To assess the frontal sinuses, place your thumbs just beneath the bony brow ridge, specifically on the supraorbital ridge above the eye socket. Apply gentle but firm pressure, directing the force slightly upward and inward beneath the bone. Avoid applying pressure directly onto the eyeball, which can cause significant discomfort. Comparing the sensitivity on both sides helps determine if the tenderness is unilateral or bilateral.
Maxillary Sinuses
For the maxillary sinuses, which are situated in the cheekbones, place your thumbs just below the zygomatic bone, alongside the nose. Apply gentle pressure in an upward and inward direction toward the cheekbones. Simultaneous palpation of both sides allows for an easy comparison of tenderness between the left and right maxillary cavities.
Interpreting Tenderness and When to Seek Care
Tenderness or localized pain during sinus palpation is associated with inflammation, often called sinusitis. When the sinus lining swells, trapped fluid and pressure cause pain when external pressure is applied to the overlying bone. A slight feeling of pressure is normal, but sharp, reproducible pain may indicate a buildup of infection or fluid.
Tenderness alone is not diagnostic, but it is suggestive when combined with symptoms like discolored nasal discharge, congestion, or a persistent headache. Most acute sinus infections resolve on their own, but medical attention is necessary if symptoms persist for more than seven to ten days without improvement or if they worsen. Immediate medical care should be sought for severe signs such as a fever over 102°F, confusion, severe headache, or any vision changes, as these may signal a serious complication.