A 35 year old male presented with nasal discharge, facial pain and fever which subsided with a course of antibiotics and antihistaminics, which recurred again after 2 months. O/E mucopurulent discharge from middle meatus, and inflammed sinus openings, investigationof choice
**Core Concept**
The patient is presenting with symptoms of recurrent sinusitis, characterized by nasal discharge, facial pain, and fever, which have recurred after initial treatment with antibiotics and antihistamines. This indicates a chronic or recurrent inflammatory process involving the paranasal sinuses.
**Why the Correct Answer is Right**
The investigation of choice for diagnosing chronic or recurrent sinusitis is a **Computed Tomography (CT) scan of the paranasal sinuses**. This imaging modality is essential for visualizing the sinus anatomy, detecting mucosal thickening, and assessing for any anatomical variations or obstructions that may contribute to sinusitis. A CT scan can also help identify any complications such as orbital or intracranial extension of the disease.
**Why Each Wrong Option is Incorrect**
**Option A:** A plain radiograph of the sinuses may show mucosal thickening, but it lacks the sensitivity and resolution to detect subtle changes in sinus anatomy and mucosal detail, making it a less ideal choice for diagnosing chronic or recurrent sinusitis.
**Option B:** Magnetic Resonance Imaging (MRI) may be useful in evaluating the soft tissue involvement and complications of sinusitis, but it is not the primary imaging modality for diagnosing chronic or recurrent sinusitis due to its limited ability to visualize bony structures and sinus anatomy.
**Option C:** Endoscopy of the nasal cavity and sinuses may be useful for diagnosing and treating chronic or recurrent sinusitis, but it is not the primary imaging modality for diagnosing the condition.
**Option D:** Positron Emission Tomography (PET) scan is not typically used for diagnosing chronic or recurrent sinusitis, as it is more useful for evaluating metabolic activity and detecting malignancies.
**Clinical Pearl / High-Yield Fact**
A CT scan of the paranasal sinuses is essential for diagnosing and managing chronic or recurrent sinusitis, and should be performed in patients with persistent or recurrent symptoms despite initial treatment.
**Correct Answer: C. Endoscopy of the nasal cavity and sinuses.**