To the Editor.
—The review and study by Williams and Simel1 is an admirable attempt to answer the often-asked question, "Does this patient have sinusitis?" This is a problem that most primary care physicians should be prepared to deal with and treat appropriately. I have several concerns with the facts as stated in this article. The authors state that sinus aspiration and culture is the "gold standard"; however, this is not often used because of the difficulty in obtaining a specimen and the difficulty in culturing the anaerobic bacteria responsible for much of chronic sinusitis. They in turn refer to sinus roentgenograms as a readily obtained and pragmatic reference standard.A four-view sinus series may be useful as an adjunct to the clinical examination in diagnosing acute sinusitis, especially acute frontal sinusitis. However, because of the often-reported discordance between plain films and sinus computed tomography (CT)2-4 (the accepted