title: A tender sinus does not always mean rhinosinusitis.
abstract: BACKGROUND
  Sinus tenderness has not been quantitatively assessed.
  
  
  OBJECTIVE
  We sought to compare sinus and systemic tenderness in rhinosinusitis, allergic rhinitis, and chronic fatigue syndrome (CFS), and healthy (non-CFS) groups.
  
  
  METHODS
  Cutaneous pressures (kg/cm(2)) causing pain at 5 sinus and 18 systemic sites were measured in acute and chronic rhinosinusitis, active allergic rhinitis, healthy non-CFS/no rhinosinusitis, and CFS subjects.
  
  
  RESULTS
  Sinus thresholds differed significantly (P </= 10(-11), ANOVA) between non-CFS/no rhinosinusitis (1.59 +/- 0.14 kg/cm(2), mean +/- 95% CI, n = 117), allergic rhinitis (1.19 +/- 0.31, n = 30), exacerbations of chronic rhinosinusitis (1.25 +/- 0.26, n = 25), non-CFS/chronic rhinosinusitis (1.23 +/- 0.27, n = 23), acute rhinosinusitis (1.10 +/- 0.20, n = 22), CFS/no rhinosinusitis (0.98 +/- 0.15, n = 70), and CFS/chronic rhinosinusitis (0.78 +/- 0.12, n = 56). Systemic pressure thresholds were lower for CFS (1.46 +/- 0.15) than for non-CFS (2.67 +/- 0.22, P </= 10(-11)).
  
  
  CONCLUSIONS
  The lower sinus thresholds of rhinosinusitis groups validated the sign of sinus tenderness. Sinus and systemic thresholds were both 44% lower in CFS than in non-CFS subjects, suggesting that systemic hyperalgesia contributed to CFS sinus tenderness and "rhinosinusitis" complaints.
authors.affiliation: Chronic Pain and Fatigue Research Center, Division of Rheumatology, Immunology and Allergy, Georgetown University, Washington, DC 20007-2097, USA.
authors.forename: K
authors.initials: K
authors.lastname: Naranch
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Park
authors.forename: M S
authors.initials: MS
authors.lastname: Repka-Ramirez
authors.forename: A
authors.initials: A
authors.lastname: Velarde
authors.forename: D
authors.initials: D
authors.lastname: Clauw
authors.forename: J N
authors.initials: JN
authors.lastname: Baraniuk
mesh_terms: D000208:Acute Disease; D000328:Adult; D002908:Chronic Disease; D003937:Diagnosis, Differential; D015673:Fatigue Syndrome, Chronic / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D017288:Pain Threshold; D010256:Paranasal Sinuses / Q000503:physiopathology*; D011312:Pressure / Q000009:adverse effects*; D012220:Rhinitis / Q000175:diagnosis* / Q000503:physiopathology*; D012221:Rhinitis, Allergic, Perennial / Q000175:diagnosis* / Q000503:physiopathology*; D012852:Sinusitis / Q000175:diagnosis* / Q000503:physiopathology*; D014110:Touch / Q000502:physiology*