Sinus Transillumination Test

The Sinus Transillumination Test is a non-invasive clinical technique that uses a focused light source to assess the presence of fluid, infection, or masses in the paranasal sinuses—primarily the maxillary and frontal sinuses. The test is based on the principle that healthy, air-filled sinuses transmit light, while fluid-filled or blocked sinuses do not.

How the Test is Performed

  • Setting: The test is performed in a completely dark room to enhance visibility.

  • Procedure:

    • A bright light (transilluminator, penlight, or otoscope) is pressed firmly against the skin over the sinus to be evaluated (either below the eyebrow for frontal sinuses or on the cheek for maxillary sinuses).

    • Maxillary sinus: Place the light source over the lower orbital rim or below the inner aspect of the eye, shining toward the hard palate. The patient keeps their mouth open, and the examiner looks for an orange/red glow on the roof of the open mouth.

    • Frontal sinus: Place the light under the brow, pointing the beam upward, and look for a dim red/orange glow over the frontal area.

  • Interpretation:

    • Normal: Clear, symmetric red/orange glow appears (healthy, air-filled sinuses).

    • Abnormal: Diminished or absent glow (“opaque,” “dull”) suggests fluid (e.g., acute sinusitis), thickened mucosa, cysts, or masses blocking light transmission.

    • Compare both sides; symmetric dimness might be normal anatomical variation, but unilateral opacification is more likely pathological.

Clinical Significance

  • The Sinus Transillumination Test is a screening tool to help identify fluid or mass in the sinuses, supporting consideration of sinusitis or other pathology as a cause of facial pain or pressure.

  • It cannot reliably distinguish viral from bacterial sinusitis, nor is it highly sensitive or specific—expertise in interpretation is needed.

  • It is quick, safe, and radiation-free, but not a substitute for advanced imaging (CT, MRI) when necessary.

Assessment

  • Use this test as part of initial screening for clients presenting with facial pain, sinus congestion, headache, or pressure suggestive of sinus involvement.

  • Record which sinus region(s) showed diminished glow and sides affected, and ask about accompanying symptoms (discharge, congestion, fever).

  • Always compare sides and note any abnormalities prior to beginning facial, head, or sinus massage.

Treatment

  • If the test is abnormal:

    • Avoid vigorous facial massage, deep pressure, or percussive techniques over suspected infected or fluid-filled sinuses.

    • Focus on gentle lymphatic drainage, relaxation, and supportive sinus massage for congestion/pain.

    • Educate on hydration, nasal irrigation, positioning, and encourage clinical evaluation if acute pain, fever, or persistent symptoms are present.

  • If acute infection is suspected or confirmed, postpone intensive facial work until medical clearance is obtained.

Safety and Referral

  • Refer to a physician/ENT specialist if signs of severe/unilateral blockage, persistent pain, or associated systemic infection are noted, or if symptoms do not resolve after supportive care.

  • Massage therapists should not attempt to “diagnose” specific pathogen cause or treat severe sinusitis—limit intervention to gentle supportive care.