Does This Patient Have Sinusitis?

Robert B. Baker, MD
JAMA. 1994;271(7):502. doi:10.1001/jama.1994.03510310031021.
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To the Editor.  —The Rational Clinical Examination entitled "Does This Patient Have Sinusitis?" by Williams and Simel1 contained an excellent review of the physical signs found in acute sinusitis. However, no mention was made of the characteristic "bad breath" odor found in many patients with this disorder. While odors may also be attributable to poor local hygiene, foreign bodies in the nares, other infections, or simple mouth breathing, I have found this odor quite sensitive in detecting sinusitis. Barness2 makes mention of it as does Green3 in his text. Indeed, many patients in my practice who have presented with a chief complaint of bad breath have had other characteristic findings of sinusitis as well as opacified sinuses on roentgenogram.I feel that we should use all of our senses, including olfaction, as diagnostic aids. Olfaction is certainly cost-effective!


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