Sinus palpation is a straightforward, non-invasive method used to assess for inflammation or pressure within the air-filled cavities of the face. This technique involves applying controlled pressure over specific facial bones to determine if the underlying sinus structures are experiencing discomfort. It serves as a preliminary diagnostic tool, used for self-assessment or as part of a professional physical examination, to help identify potential issues like acute or chronic sinusitis.
Understanding Sinus Placement
To perform a proper check, it is necessary to know the exact location of the two primary sinuses accessible for manual examination. The frontal sinuses are situated within the frontal bone, located directly above the eyes behind the bony ridge of the eyebrow. These cavities are the most superior of the accessible sinuses.
The maxillary sinuses, which are the largest of the paranasal sinuses, are positioned bilaterally in the cheekbones (maxilla), beneath the eyes. They rest on either side of the nose. While the ethmoid and sphenoid sinuses exist, they are situated deeper within the skull and cannot be directly evaluated using the palpation technique.
Applying the Palpation Technique
The process of palpation requires a firm but gentle touch, applying pressure symmetrically to compare both sides of the face. For the frontal sinuses, place your index fingers or thumbs underneath the bony ridge of the eyebrows, avoiding pressing directly onto the eyeball. Direct the pressure slightly upward and inward beneath the supraorbital ridge, as this is where the thin bone over the sinus is located. Hold this pressure consistently for a few seconds to gauge any sensation.
To check the maxillary sinuses, move your thumbs or index fingers to the area just below the cheekbones, lateral to the sides of the nose. Apply steady, upward pressure into the bony area under the orbital rim. Avoid circular rubbing or excessive force; the goal is to gently compress the soft tissue against the underlying bone to identify tenderness. Maintain symmetrical pressure on both sides to accurately compare the sensation.
What Tenderness Indicates
When performing this check, a slight feeling of pressure is a normal response due to the manipulation of tissue and bone. True tenderness is characterized by a distinct sensation of pain or heightened sensitivity when pressure is applied. This tenderness is a significant sign, often suggesting that the tissues lining the sinus cavities are inflamed or swollen.
Tenderness over the frontal or maxillary sinuses commonly correlates with sinusitis, which is inflammation of the sinus lining frequently caused by infection. If the pain is significantly greater on one side, or if it is accompanied by symptoms like thick, discolored nasal discharge or fever, inflammation is highly likely. Persistent or worsening tenderness that lasts longer than a week, or is associated with high fever, should prompt a consultation with a healthcare provider for a definitive diagnosis.