title: Brief report: a red streak in the lateral recess of the oropharynx predicts acute sinusitis.
abstract: OBJECTIVE
  To evaluate the oropharyngeal red streak sign for diagnosing acute sinusitis.
  
  
  METHODS
  Exploratory cohort study.
  
  
  METHODS
  A Veterans Affairs medical center urgent care center.
  
  
  METHODS
  Sixty consecutive subjects presenting with nasal symptoms lasting 4 weeks or less.
  
  
  RESULTS
  Each subject underwent a structured history and physical examination, followed by a sinus computed tomography (CT) scan. Acute sinusitis was defined by an air-fluid level or opacification of 1 or more sinuses on CT imaging. Twenty-seven subjects were diagnosed with sinusitis. A localized red streak in the lateral recess of the oropharynx was associated with sinusitis, with a positive likelihood ratio (LR+) and 95% confidence interval (CI) of 2.11 (1.23, 3.63) and a negative likelihood ratio (LR-) and 95% CI of 0.44 (0.24, 0.83). Opacity on maxillary or frontal sinus transillumination was also associated with sinusitis (LR+ of 1.89; CI 1.03, 3.32 and LR- of 0.56; CI 0.32, 0.96). Symptom duration > 10 days was associated with acute sinusitis with an LR+ of 1.89 (1.06, 3.59). A history of facial pain (LR+ of 0.59; CI 0.39, 0.90 and LR- of 2.85; CI 1.27, 6.41) and the finding of sinus percussion tenderness (LR+ of 0.22; CI 0.05, 0.90 and LR- of 1.88; CI 1.17, 3.03) were inversely associated with sinusitis.
  
  
  CONCLUSIONS
  The oropharyngeal red streak may be an accurate physical sign for diagnosing acute sinusitis. This sign should be included in future studies of clinical diagnostic criteria for acute sinusitis.
authors.affiliation: Division of General Internal Medicine and Geriatrics, VA San Diego Healthcare, San Diego, CA 92161, USA. colin.thomas@med.va.gov
authors.forename: Colin
authors.initials: C
authors.lastname: Thomas
authors.forename: Vitali
authors.initials: V
authors.lastname: Aizin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D009960:Oropharynx / Q000000981:diagnostic imaging / Q000473:pathology*; D011237:Predictive Value of Tests; D012852:Sinusitis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014172:Transillumination / Q000379:methods*; D014481:United States