11/10/03 Is chronic sinusitis the cause of chronic fatigue?SummarySome otolaryngologists have noted that patients with chronic sinusitis often complain of chronic fatigue. But should chronic sinusitis be considered in the differential diagnosis of unexplained chronic fatigue (UCF)? Chester et al of the Georgetown Medical Center in Washington, DC carried out a pilot case-control study. In a group of 297 patients <41 years, 65 reported UCF and 33 reported bodily pain (with both type of symptoms in 26 individuals). Compared to the patients without UCF, those with UCS more commonly reported frontal headache (Odds Ratio, OR=13.6), facial pressure (OR=9.7), tender cervical nodes (OR=9.2), nasal obstruction (OR=4.2), some throat (OR=3.1) and post-nasal drip (OR=2.1). Reference Arch Intern Med 2003; 163:1832-36 Editor's Comments These findings are provocative but are by no means conclusive. The authors did not describe any objective evidence of chronic sinusitisin those with UCF (as compared to those without UCF). Although theOdds Ratios (OR) look impressive, at least some of the symptomsdescribed are rather typical of that described by individuals diagnosed with the Chronic Fatigue Syndrome, a disorder of unknown etiology where chronic infection, including that involving the sinuses has been looked for thoroughly by experienced investigators with negative findings. Having said that, I believe it conceivable that cytokines released in sites of really active sinusitis could have systemic effects. For years, chronically infected sinuses were postulated by some to cause a variety of chronic systemic problems, ranging from urticaria to arthritis. The evidence for this association has been either weak or lacking. Further investigation of a possible relationship between sinusitis and UCF is likely indicated.
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