The Common Cold in Patients with a History of Recurrent Sinusitis Increased Symptoms and Radiologic Sinusitislike Findings

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Original Research

The Common Cold in Patients with a History of Recurrent Sinusitis Increased Symptoms and Radiologic Sinusitislike Findings

J Fam Pract. 2001 January;50(1):26-31

References

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Related Resources:

Johns Hopkins Asthma & Allergy page Information on epidemiology, triggers, drug therapy and immunotherapy. Case studies and other features. www.hopkins-allergy.org/sinusitis/index.html
National Institute of Allergy and Infectious Diseases Information on NIAID research projects and opportunities, publications, as well as the agency’s Immune Tolerance Network www.niaid.nih.gov/default.htm
Common Cold Centre General information for patients www.cf.ac.uk/biosi/associates/cold/info.html

Symptoms and Signs

The date of recruitment to the study was called day 1. The study patients filled in a form twice a day concerning their symptoms on days 1, 2, and 3. To determine a score for each symptom, they rated the following 10 using a scale from 0 (not present) to 10 (very severe): runny nose, nasal stuffiness, sneezing, sore throat, facial pain, cough, fatigue or lethargy, muscle aches, chills, and headache. The individual symptom scores were summed for each subject, resulting in a total score calculated separately for each day and overall. On day 21, only the presence of any acute symptoms was recorded.

An ear, nose, and throat specialist examined all patients on days 1 and 21. The examiner knew the subject’s history but was unaware of all other findings. Nasoendoscopy was performed with a rigid 4-mm Storz 0° endoscope, and various pathologic findings were recorded.

Radiologic Examinations

We viewed coronal computed tomographic (CT) slices including the nasal passages and all the paranasal sinuses on days 1 and 21 (Sytec 3000 Plus or HiSpeed Advantage scanner, General Electric Medical Systems, Milwaukee, Wis). Two experienced radiologists and 3 ear, nose, and throat specialists evaluated the CT scans independently from a hard copy. In cases of disagreement the 2 groups reassessed the finding jointly to reach consensus. The reviewers were blinded to all other parameters including the history. The radiologic sinusitislike changes included total opacification, an air-fluid level, or more than 5-mm mucosal thickening. Also, the presence of an air-fluid level or total opacification in any sinus was recorded.

Microbiologic Studies

Viral antigens from the nasal mucus were detected by time-resolved fluoroimmunoassay for the following common respiratory viruses on day 1: adenovirus; respiratory syncytial virus; parainfluenza types 1, 2, and 3; and influenza A and B.⁴ Virus cultures from nasopharyngeal swaps for these viruses and for rhinovirus were done using the Ohio strain HeLa cells and human foreskin fibroblasts according to a procedure described previously.⁵ Rhinoviruses were also detected by reverse transcription-polymerase chain reaction (PCR).^6,7 Some of the picorna viruses could not be identified further with these PCR assays. Mycoplasma immunoglobulin M (IgM) antibodies from the serum samples taken on day 21 were measured with 2 commercial kits (SeroMP, Savyon Diagnostics Ltd, Israel; and Mycoplasma pneumoniae IgM ELISA, Novum Diagnostica GmbH, Germany). A true-positive result in both tests was required for a definitive diagnosis. Specimens for aerobic and anaerobic bacterial cultures were taken from the nasopharynx and with the help of an endoscope from the middle meatus on day 1. The swabs were inoculated onto normal and chocolated sheep blood agar plates and onto fastidious anaerobe agar plates containing sheep blood (Lab M, Bury, England), according to routine procedures.

Treatment

On the basis of the overall clinical impression (no specific criteria were given) and radiologic findings, the patients designated to have bacterial sinusitis were given either amoxicillin 500 mg 3 times daily for 7 days, or trimethoprim-sulfamethoxazole 160 mg plus 800 mg twice daily for 7 days in case of penicillin allergy. All of the patients were allowed nasal decongestants and mild analgesics.

Statistical Analysis

To analyse the relationship between the different variables and the history of recurrent or no sinusitis, we performed the {c}² test in case of proportions, the Student t test for normally distributed continuous variables, and the Mann-Whitney U test on nonparametric variables. All significance tests of hypotheses were 2 tailed.

Results

Patients

During 2 periods between February 1 and May 15, 1996, and August 15 and December 31, 1996, a total of 52 patients were enrolled, 26 in the sinusitis-prone group and 26 in the control group. The patients in both series were enrolled in even numbers during the entire study period (16 sinusitis-prone patients and 12 control patients in the first period and 10 and 14 patients, respectively, in the second). Three sinusitis-prone patients and one control subject were excluded because of an ongoing antimicrobial treatment, a broken CT apparatus at the time of the follow-up visit, nasal polyps in nasoendoscopy, and one doubtful sinusitis episode in a control subject’s history. Thus, 48 patients completed the study: 23 in the sinusitis-prone group and 25 in the control group. One sinusitis-prone subject did not return the symptom scores and was excluded from the analyses of the symptoms.

The background characteristics of the patients are shown in Table 1. The sinusitis-prone patients reported a significantly higher mean number of common cold episodes per year than the control patients (P=.01), but the 2 groups were similar in terms of the other background characteristics.