Usual care and outcomes in patients with sinus complaints and normal results of sinus roentgenography.
OBJECTIVE
To describe the usual care and outcomes of patients with sinus symptoms and normal sinus roentgenograms.


METHODS
Prospective cohort with 60-day follow-up.


METHODS
Medical outpatient clinics at a university-affiliated Veterans Affairs medical center.


METHODS
Consecutive patients (n = 126, 88% follow-up rate) with rhinorrhea (88%), facial pain (65%), or self-suspected sinusitis (24%) and normal four-view sinus roentgenography (median age, 47 years; 90% male; 56% white).


METHODS
Fourteen-day self-reported symptom status.


RESULTS
Sixteen history and five physical examination items were recorded by clinicians who were blinded to the results of sinus roentgenography; clinical diagnoses and treatment plans were formulated by clinicians with knowledge of the results of sinus roentgenography. Clinical diagnoses included allergic rhinitis (27%), sinusitis (22%), viral respiratory tract infection (14%), and bronchitis (11%). Treatments included administration of antibiotics (40%), decongestants (32%), antihistamines (25%), and nasal steroids (9%). Forty-nine percent achieved 14-day clinical success (13.5% were cured and 36% were much improved). Improvement was more likely among patients who presented with cough (odds ratio, 3.0; 95% confidence interval, 1.3 to 6.9) but was less likely among those with itchy eyes (odds ratio, 0.18; 95% confidence interval, 0.07 to 0.43). Patients with cough and without itchy eyes had significantly shorter clinical courses (P = .003). Of patients who achieved clinical success on day 14, 30% relapsed or recurred by day 60.


CONCLUSIONS
With usual medical care, the syndrome of sinus symptoms and normal results of sinus roentgenography persists for at least 14 days in many patients; however, patients with cough but without itchy eyes may have shorter clinical courses.
Holleman
D R
DR
Medical Service, Lexington Veterans Affairs Medical Center.
Williams
J W
JW
Simel
D L
DL
D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D011859:Radiography; D012016:Reference Values; D012141:Respiratory Tract Infections / Q000000981:diagnostic imaging / Q000628:therapy*; D012852:Sinusitis / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome