Plain film x-rays of the sinuses should not be ordered in the work-up of sinusitis. Plain films have poor sensitivity and specificity and they cannot be relied upon to confirm or reject the diagnosis of either acute or chronic sinusitis. Findings such as air-fluid levels and complete sinus opacification are not reliably present in rhinosinusitis, and cannot differentiate between viral and bacterial etiologies. The complicated anatomy of the ethmoid sinuses and critical sinus drainage pathways are not delineated effectively with plain films, and are inadequate for operative planning. Given that the findings of a sinus x-ray cannot be relied upon to diagnose rhinosinusitis, guide antibiotic prescribing, or plan surgery, they do not provide value in patient care and should be avoided.
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