Relevance of the conventional Waters' view in evaluating chronic bacterial maxillary sinusitis

Considerable controversy exists as to whether X-ray examination of the sinuses is a reliable diagnostic guide or not, in cases of chronic bacterial maxillary sinusitis, as many factors apart from infection in the sinuses may produce radiographic signs on the X-ray film. With those facts in mind, it was decided to investigate the diagnostic reliability of Waters' view in these cases. The present work showed that radiographic signs of chronic maxillary sinusitis have different diagnostic and predictive reliabilities ranging from the almost complete inaccuracy of reduced translucency or 'veiling' of the sinus to the perfect validity of 'fluid levels' or polyps within the sinus. In general, while Waters' view undoubtedly yields valuable information regarding maxillary sinus pathology, nevertheless the presence of various sources of error while exposing and reading the film should make one appreciate that radiographic diagnosis is not absolute and should only be considered in the light of the clinical findings and possibly other investigations.