You the perform a physical exam to further support your differential diagnosis:

Examination of the middle meatus may show purulent secretions:

It is also important to look for causes of rhinosinusitis including structural obstruction, polyps, or a foreign body.

Transillumination is also a neat test that can also be done, but is not a very useful as a diagnostic test.

What is transillumination?

It's now time to consider some investigations. What is the next thing you would do?

• Sinus aspirate culture
• X-Ray
• CT Head
• Liver biopsy
• No investigations needed