BACKGROUND: We evaluated whether the symptoms and signs and radiologic findings during a common cold are similar in patients who have and have not suffered from recurrent sinusitis.
METHODS: We recruited 2 series of volunteer cases from February 1, 1996, to December 31, 1996. Twenty-three adults who claimed to have suffered from recurrent sinusitis and 25 who had never had sinusitis were examined during the period of a self-diagnosed cold of 48 to 96 hours’ duration and again after 21 days. Symptom scores were recorded, nasoendoscopy and computed tomography scans were performed, and viral and bacterial specimens were taken.
RESULTS: The patients with a history of sinusitis had significantly higher mean symptom scores than the control patients (P=.04) and had radiologic sinusitislike changes more often (65% [15] vs 36% [9]; difference 29% [95% confidence interval, 2%-56%]; P=.04). The viral etiology of the common cold (verified in 67% of the episodes) was similar in both groups. Pathogenic bacteria were isolated from the middle meatus in 24% (6) of the control patients and only 9% (2) of the sinusitis-prone patients (P=.15). On the basis of the symptomatology, radiologic findings, and bacterial cultures only 2 patients in the sinusitis-prone group should have been treated with antimicrobials.
CONCLUSIONS: Some patients are susceptible to both sinusitislike symptoms and radiologic findings during viral common colds. This may cause them to consult their physicians earlier and more often during viral colds, which may result in unnecessary antibiotic treatments. Nasopharyngeal bacteriological cultures may prove to be useful in ruling out bacterial sinusitis.
Sinusitis is the most common condition for which antibiotics are prescribed in ambulatory practice, according to the National Ambulatory Medical Care Survey.1 There are many patients who are given a diagnosis of sinusitis and treated with antimicrobials during almost all common colds. Chronic sinusitis is the most common self-reported chronic illness in the United States.2 Our experience is that patients who have suffered from recurrent sinusitis episodes often seek medical help during an early stage of a respiratory infection. This may lead to a viral common cold being unnecessarily treated with antibiotics, because the diagnosis of bacterial sinusitis remains difficult to make.
We studied whether sinusitis-prone patients have more severe or different symptoms compared with healthy controls at the beginning of a respiratory infection that could increase their consultation prevalence. Also, we evaluated whether there are differences in the clinical and radiologic findings between these 2 groups that could lead the physicians to regard the disease as bacterial sinusitis. To do this we compared these items and the microbiologic findings during one episode of a common cold in patients with a history of recurrent sinusitis and in patients who had never had sinusitis.
Methods
Patients
The patients were recruited by solicitations for volunteers with a community-acquired common cold by advertising in a newspaper distributed in Oulu, a city in Finland with approximately 120,000 inhabitants. A trained nurse screened the volunteers for eligibility by telephone in a way designed to mask the specific criteria for enrollment in the study. Two sets of volunteers were enrolled. The sinusitis-prone group included persons who claimed to have suffered from at least 2 yearly episodes of acute maxillary sinusitis during the previous 2 years. The control group consisted of persons who had never had clinical sinusitis. The other criteria were: aged older than 18 years, symptoms of acute common cold for 48 to 96 hours, presence of nasal symptoms, no chronic sinusitis or nasal polyps, no previous paranasal surgery, no ongoing antibiotic treatment, no pregnancy, and no diagnosed immunologic disorder. The Ethical Committee of the University of Oulu approved our study, and written informed consent was obtained from all patients.
To assess the selection process, we gathered data on the persons contacting the study nurse during one randomly selected week of the inclusion period (week 51, 1996). During this 1 week, 81 patients contacted the nurse. Of these, 43 were excluded because they had symptoms for more than 96 hours, 23 because they had had too few previous sinusitis episodes, 4 because they had operations for sinus problems, 4 because they had been taking an antibiotic treatment during the previous month, and 4 because they did not have nasal symptoms, leaving 3 patients (4%) who entered the study.
The patients were unaware of the aims of our study. They were asked to complete questionnaires containing items on various background factors. To study allergic background, we performed skin prick tests with 18 common inhalants (Prick-Lancett, Ewo Care AB, Gislaved, Sweden) as described previously,3 measured total serum immunoglobulin E (IgE) with the QuantiCLONE Total IgE Kit (Kallestad Diagnostics, Inc, Chaska, Minn), and recorded nasal eosinophilia (proportion of eosinophils exceeding 10% of nucleated cells on nasal smear).