 |
|
Usual Care and Outcomes in Patients With Sinus Complaints and Normal Results of Sinus Roentgenography
Donald R. Holleman, Jr, MD;
John W. Williams, Jr, MD, MHS;
David L. Simel, MD, MHS
Arch Fam Med. 1995;4(3):246-251.
Abstract
| |
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 universityaffiliated Veterans Affairs medical center.
Patients
Consecutive patients (n=126, 88% follow-up rate) with rhinorrhea (88%), facial pain (65%), or selfsuspected 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.
Author Affiliations
From the Medical Service, Lexington Veterans Affairs Medical Center, and the Division of General Medicine and Geriatrics, the University of Kentucky, Lexington (Dr Holleman); Ambulatory Care, Audie L. Murphy Memorial Veterans Affairs Medical Center, and the Division of General Internal Medicine, the University of Texas Health Science Center at San Antonio (Dr Williams); and the Health Services Research Field Program, Durham Veterans Affairs Medical Center, and the Division of General Internal Medicine, Duke University Medical Center, Durham, NC (Dr Simel).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Determinants for the course of acute sinusitis in adult general practice patients
Stalman et al.
Postgrad. Med. J. 2001;77:778-782.
ABSTRACT
| FULL TEXT
A Clinical Trial of Hypertonic Saline Nasal Spray in Subjects With the Common Cold or Rhinosinusitis
Adam et al.
Arch Fam Med 1998;7:39-43.
ABSTRACT
| FULL TEXT
|
