ENT eval & CT scan. An ENT evaluation and a sinus ct scan, together, can usually determine whats going on and what is needed.
Hole? In sphenoid. The most definitive test to assess the integrity of the sphenoid bone/ sinus is a ct scan of the paranasal sinuses. Depending on symptoms and what one is looking for the scan protocol may call for photographing in different orientations.
Hole is normal. The best test to evaluate the sphenoid sinus is usually a ct scan. The natural drainage hole should be open and secretions should not build up. When they do they cause infection and sometimes pain. Occasionally an MRI is necessary to look for certain growths or rumors in the sphenoid sinus.