Sinus palpation is a physical examination technique involving the application of light pressure to specific areas of the face. This procedure assesses whether the underlying air-filled cavities, known as the paranasal sinuses, are tender or painful. Tenderness upon palpation suggests inflammation, congestion, or infection within these facial structures. This self-assessment provides an initial indication of sinus issues before seeking professional medical guidance.
Mapping the Paranasal Sinuses
The paranasal sinuses are a group of four air-filled spaces surrounding the nasal cavity, though only two pairs are accessible for external palpation. These cavities are named for the facial bones in which they reside. The frontal sinuses are situated in the forehead, located just above the eyes within the brow bone, known as the supraorbital ridge.
The second accessible pair is the maxillary sinuses, which are the largest of the paranasal sinuses. They are located in the cheekbones, specifically in the maxillary bone beneath the eyes and alongside the nose. The ethmoid and sphenoid sinuses, situated deeper within the skull between the eyes and behind the eyes, respectively, are not reachable through external palpation. Understanding the exact surface locations of the frontal and maxillary sinuses is necessary to ensure the pressure is applied directly over the bony walls of the cavities.
Step-by-Step Palpation Technique
Before beginning the examination, it is helpful to start by sitting upright in a comfortable position, which assists in draining the sinuses and ensures proper access. Begin with clean hands, using the pads of the thumbs or index fingers for the most precise application of pressure. The goal is to apply firm but gentle pressure, not forceful enough to cause injury or significant discomfort in a healthy sinus.
Palpating the Frontal Sinuses
To assess the frontal sinuses, place the pads of both thumbs directly under the bony ridge of the eyebrows, avoiding the eye socket itself. The ideal point is slightly medial, near the bridge of the nose. Apply a gentle, upward-and-inward pressure against the bone and hold it for a few seconds.
Note any sensation of pain, aching, or sharp tenderness experienced during the application of this pressure. A mild sensation of pressure is expected, but any distinct pain should be noted for comparison.
Palpating the Maxillary Sinuses
For the maxillary sinuses, shift the pads of your thumbs to the cheekbones, inferior to the eyes and slightly lateral to the sides of the nose. This area is directly over the front wall of the maxillary bone. Apply a gentle, circular motion or a sustained downward-and-inward pressure against the bone.
Hold the pressure briefly and assess the feeling. Tenderness in this area can sometimes be confused with dental pain, as the roots of the upper teeth project into the floor of the maxillary sinus. After checking both areas, release the pressure and compare the sensations felt on the left side of the face to those on the right.
Understanding the Results of Palpation
The primary purpose of sinus palpation is to identify localized tenderness, which is the body’s reaction to the pressure of an underlying inflammatory process. A normal finding is the sensation of mild pressure or no discomfort at all when the appropriate force is applied. If this is the case, the sinus lining is likely not inflamed or swollen.
Abnormal findings manifest as pain, sharp tenderness, or a distinct ache that is disproportionate to the pressure being applied. This tenderness often suggests that the mucous membrane lining the sinus cavity is inflamed or that fluid buildup is causing pressure against the bony walls.
Tenderness, particularly when accompanied by other symptoms like thick, colored nasal discharge, facial pain, or fever, may suggest sinusitis, which is an inflammation of the sinus tissue. However, tenderness alone is not a definitive diagnosis for infection, as other factors like migraines or allergies can also cause facial sensitivity. If you experience severe, unremitting pain, significant swelling, or symptoms that persist beyond ten days, consulting a healthcare professional is necessary for an accurate diagnosis and treatment plan.