SELECTED ARTICLES FROM THE RECENT LITERATURE 2004
9/10/04
How to evaluate patients with chronic sinusitis
Summary
Background -Rhinosinusitis (RS) is a very common disorder diagnosed at one time or another in perhaps 15% of the US population. There is still some difference of opinion about the best way to evaluate patients with suspected chronic RS.
Findings - Muzaffar and Stankiewicz of the Loyola/Stritch School of Medicine in Chicago, IL recently described their approach to suspected chronic RS. They find the major symptoms of chronic RS to be facial pain/pressure, nasal congestion with persistent purulent nasal discharge and disordered sense of smell. If endoscopic exam reveals thick, purulent discharge from the sinus ostia, one can make a prescriptive diagnosis of chronic RS and treat with antibiotics and anti-inflammatory agents without the need to obtain CT exam of the sinuses. However, the CT should be obtained when the clinical picture/exam findings are not typical.
Reference
J Respir Dis 2004;25:228-33
Editor's Comments
There is considerable debate about when to obtain sinus CT exams in the evaluation of possible chronic RS. Some authors report that the "classic" findings of pain and tenderness over the sinuses is not that common in chronic RS, defined by a significant thickening of the sinus mucosa seen on CT exam. Dental referred pain is even less common. However, other investigators caution that sinus CT exam may show transient thickening of the sinus mucosa for up to several weeks after a prominent viral URI, sometimes misdiagnosed as chronic RS. Of note, there is an ongoing debate as to how often defined bacterial infections are found as definite causes of chronic RS, possibly explaining the often unimpressive clinical response to even prolonged therapy with usual anti-microbial agents in cases diagnosed as chronic RS.
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