Role of X-rays in Rhinology


X-rays in the present day context are considered to be outdated by rhinologists. CT scan images have replaced conventional X-ray imaging, but X-rays still have a role in the field of rhinology. The inherent advantages like easy availability and cost effectiveness make this investigation still relevant in the present day scenario. Bony lesions involving the nose and sinuses can be evaluated with a reasonable degree of accuracy by performing conventional radiographs. Air present inside the paranasal sinuses serves as excellent contrast medium for plain x-ray evaluation. Pathologies involving the paranasal sinuses encroach upon these air spaces causing alterations in their translucency.


With the advent of CT / MRI imaging, plain radiographs are losing their relevance as far as rhinological diagnosis is concerned. This article attempts to explore the currently prevailing indications for the use of plain radiographs in rhinology. Even though CT scans provide improved resolution of soft tissue densities, they have their own drawbacks like increased cost of investigation and not-so-easy availability. The paranasal sinuses are air-filled cavities. Pathology involving these structures causes varying degrees of attenuation of the air contrast medium, which can easily be observed in conventional radiographs. Certain pathological conditions can cause accumulation of fluid within the sinus cavity. This can be clearly demonstrated if plain X-rays are taken with the patient in an erect position. Fluid levels can clearly be demonstrated even in plain radiographs.

Advantages of X-ray imaging in rhinology include:

  1. Cost effectiveness of the investigation
  2. Easy availability
  3. Currently available digital X-ray imaging techniques provide better soft tissue and bone resolution when compared to conventional X-rays


Image showing patient position during X-ray of the sinus in Water’s view

Disadvantages of conventional radiographs:

  1. Plain radiographs have a false positive rate of 4%. (1)
  2. Plain radiographs have false negative rate of more than 30%. (2)
  3. There can be difficulties in patient positioning.

If the antrum in Water’s view demonstrates a loss of translucency which could be an indicator of fluid level, then another X-ray is taken with a tilt of the sagittal plane to an angle of 30 degrees. This view will clearly demonstrate movement of fluid to a new position. In this view, the fluid moves towards the lateral portion of the antrum where it can clearly be seen.

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This entry was posted in Otolaryngology (ENT), Primary Care and tagged . Volume: .

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