Sinus Transillumination: An Archaic Survival

THE following extracts are taken from W. G. Porter's Diseases of the Throat, Nose and Ear published in 1912, of which "Logan Turner" is the modern version. "Trans-illumination was introduced by Voltolini and elaborated by Heryng, and is used for the investigation of the condition of the accessory sinuses. The examination has to be carried out in a dark room. The lamp is introduced into the mouth of the patient who then closes his lips. Any denture must be removed first. On making the contact, a semicircular tache is seen under each lower eyelid if the antra transmit light; the pupils are also slightly illumined, and, if the patient closes his eyes, he has a sensation of light in them. A faint patch of light is also seen on either side of the root of the nose, due to light passing through the ethmoid labyrinth. An antrum may fail to transmit light if it is full of pus, if the walls are thick, or if it contains a solid tumour. The illumination is brighter than usual in cystic conditions, and it may be so in cases of choanal polypus arising from the interior of the antrum." The following two quotations from the same source refer tojhe frontal sinus. "A_failure to illuminate conveys no information, as it may be due to the absence of a sinus, or to disease." "Trans-illumination_does not give any assistance in arriving at a diagnosis; a skiagram affords the only conclusive proof of the presence of disease that can be obtained apart from an actual operation." These extracts exemplify the chaotic basis and fallaciousness of the procedure, namely, that whatever the result it neither proves nor excludes the presence of disease! What diagnostic test could be more inane? Yet for threequarters of a century it has withstood ridicule, the perfection of finer diagnostic tools, and the tragic lessons to be learnt by those with eyes to see and mind to analyse. The number of lives that have been lost through blind adherence to an archaic anachronism cannot be computed. I believe an important factor in its retention is its "convenience" in private practice. In a private consulting room a trans-illuminator is a possibility while an X-ray apparatus usually is not. It is so much easier to trans-illuminate in the consulting room and act directly upon the result rather than to investigate properly by referring the patient to hospital or a private radiologist for X-ray. How many E.N.T. surgeons would have their own antra punctured without convincing radiological evidence of disease?