title: Prospective observational study of chronic rhinosinusitis: environmental triggers and antibiotic implications.
abstract: BACKGROUND
  A prolonged course of antibiotic therapy is often initiated for chronic rhinosinusitis (CRS) based on symptomatology. We examined differences in clinical manifestations and underlying conditions in patients with symptoms typical for CRS. CT scan abnormality of the sinuses was the gold standard for diagnosis of CRS.
  
  
  METHODS
  We performed a prospective observational study of 125 adults with classic symptoms of CRS undergoing nasal endoscopy and sinus CT.
  
  
  RESULTS
  The patients were classified into 2 groups: (1) those with radiographic evidence of sinusitis by CT (Sx + CT) (75) and (2) those with normal CT scans of the sinus (Sx - CT) (50). Decreased smell was significantly more common in Sx + CT than in Sx - CT patients, (P = .003). Paradoxically, headache, facial pain, and sleep disturbance occurred significantly more frequently in patients with Sx - CT than in patients with Sx + CT (P < .05). The absence of mucopurulence on endoscopy proved to be highly specific for Sx - CT patients (100%). On the other hand, sensitivity was low; only 24% of Sx + CT patients demonstrated mucopurulence by endoscopy. Improvement in response to antibiotics was similar between both CRS categories.
  
  
  CONCLUSIONS
  Most symptoms considered to be typical for CRS proved to be nonspecific. Interestingly, symptoms that were more severe were significantly more likely to occur in younger patients who were Sx - CT. The efficacy of antibiotic therapy was uncertain. We suggest that objective evidence of mucopurulence assessed by endoscopy or CT should be obtained if antibiotics are to be given for prolonged duration. We recommend a moratorium for the widespread practice of a prolonged course of empiric antibiotics in patients with presumed CRS.
authors: Department of Otolaryngology, University of Pittsburgh, Pennsylvania, USA.
authors: Berrylin J
authors: BJ
authors: Ferguson
authors: Masashi
authors: M
authors: Narita
authors: Victor L
authors: VL
authors: Yu
authors: Marilyn M
authors: MM
authors: Wagener
authors: Jack M
authors: JM
authors: Gwaltney
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002908:Chronic Disease; D004724:Endoscopy; D006801:Humans; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging / Q000473:pathology; D011446:Prospective Studies; D012220:Rhinitis / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D012307:Risk Factors; D012852:Sinusitis / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents