The role of sinus imaging in the treatment of chronic cough in adults.
OBJECTIVE
To determine the appropriate role and timing of sinus imaging studies in the evaluation and treatment of chronic cough.


METHODS
Prospective study of chronic cough. All patients underwent sinus imaging, the results of which identified prospectively the following: (1) fluid in sinuses, with or without opacification, and (2) mucosal thickening. Patients then were treated using an algorithm that sequentially addresses the etiologies of chronic cough. Patients whose sinus imaging studies had demonstrated fluid were treated initially for sinusitis, but mucosal abnormalities alone were not considered an indication to change the algorithm. After workup, relationships between abnormalities on sinus imaging studies and diagnoses were determined.


METHODS
University hospital pulmonary outpatient clinic.


METHODS
Thirty-six patients (31 women, 5 men; mean age, 58.4 years). Cough duration averaged 5.2 years (range, 4 weeks to 30 years).


RESULTS
Diagnoses were made in 100% of patients, and cough resolved in 86%. Mucosal thickening correlated with sinusitis as a cause of cough in only 29% of cases.


CONCLUSIONS
Mucosal thickening is not diagnostic of sinusitis as a cause of chronic cough; in most patients, cough will resolve without treatment for sinusitis. Given this lack of specificity, it is reasonable to delay sinus imaging until after efforts at treating rhinitis have failed and, in the absence of complaint or findings of postnasal drip, until after completion of evaluation for asthma. The principles of diagnosis and treatment of chronic cough remain simple: go sequentially from the most common to the least common cause; use tools that begin with the most available and least expensive and invasive modality; then move as needed to tools that are more expensive and invasive.
Pratter
M R
MR
Division of Pulmonary and Critical Care Medicine, Cooper Hospital/University Medical Center, University of Medicine and Dentistry of New Jersey/Robert Wood Johnson Medical School at Camden, NJ, USA.
Bartter
T
T
Lotano
R
R
D000328:Adult; D000368:Aged; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D003371:Cough / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012220:Rhinitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D012852:Sinusitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D014662:Vasoconstrictor Agents