Usual care and outcomes in patients with sinus complaints and normal results of sinus roentgenography
D. R. Holleman Jr, J. W. Williams Jr and D. L. Simel
Medical Service, Lexington Veterans Affairs Medical Center.
OBJECTIVE: To describe the usual care and outcomes of patients with sinus
symptoms and normal sinus roentgenograms. DESIGN: Prospective cohort with
60-day follow-up. SETTING: Medical outpatient clinics at a
university-affiliated Veterans Affairs medical center. PATIENTS:
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). MAIN
OUTCOME MEASURE: 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. CONCLUSION: 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.
