0
September 8, 1993, Vol 270, No. 10 >
ARTICLE | September 8, 1993

Does This Patient Have Sinusitis?: Title and subTitle BreakDiagnosing Acute Sinusitis by History and Physical Examination FREE

John W. Williams, Jr, MD, MHS; David L. Simel, MD, MHS
[+] Author Affiliations

Reprint requests to the the Ambulatory Care Service, Audie L. Murphy Memorial Veterans' Hospital, 7400 Merton Minter Blvd, San Antonio, TX 78284 (Dr Williams).


JAMA. 1993;270(10):1242-1246. doi:10.1001/jama.1993.03510100092039
Text Size: A A A
Published online
Article
References

DOES THIS PATIENT HAVE SINUSITIS? 

Clinical Scenario  The patient presents to your office with a "bad cold." Her symptoms began 5 days ago when a runny nose, a scratchy throat, generalized malaise, and a nonproductive cough developed. Her symptoms are gradually improving with an over-the-counter cough medicine, but during the past 24 hours a "sinus headache" has developed. The patient is concerned that she may have "sinus." Of note, it is the middle of "cold and flu" season, and this is the fifth patient you've seen today with upper respiratory-tract symptoms.

Why Is This an Important Question to Answer With a Clinical Examination?  The patient's story is familiar to primary care clinicians. Indeed, the most frequent diagnoses made by primary care practitioners include nasal problems such as allergic and infectious rhinitis, vasomotor rhinitis, and bacterial sinusitis.1 Given the constant assault of allergens, environmental pollutants, respiratory viruses, and rapid temperature

REFERENCES

1 +
National Center for Health Statistics. National Ambulatory Medical Care Survey of Office Visits to General and Family Practitioners, January-December 1975. Advance data, No. 15; 1977.
2 +
MacKay I, ed. Rhinitis: Mechanisms and Management . Park Ridge, NJ: Parthenon Publishing; 1989;:169.
3 +
Simon HB.  Approach to the patient with sinusitis.  In: Goroll AH, May LA, Mulley AG, eds. Primary Care Medicine: Office Evaluation of the Adult Patient . Philadelphia, Pa: JB Lippincott; 1987;:883-885.
4 +
Axelsson A, Chidekel N, Grebelius N, Jensen C.  Treatment of acute maxillary sinusitis: a comparison of four different methods. Acta Otolaryngol (Stockh) . 1970;;70:71-76.
5 +
Wald ER, Chiponis D, Ledesma-Medina J.  Comparative effectiveness of amoxicillin and amoxicillin-clavulanate potassium in acute paranasal sinus infections in children: a double-blind, placebo-controlled trial. Pediatrics . 1986;;77:795-800.
6 +
Williams JW Jr, Roberts L, Distell B, Simel DL.  Diagnosing sinusitis by x-ray: comparing a single Waters view to 4-view paranasal sinus radiographs. J Gen Intern Med . 1992;;7:481-485.
7 +
Hayward MW, Lyons K, Ennis WP, Rees J.  Radiography of the paranasal sinuses: one or three views? Clin Radiol . 1990;;41:163-164.
8 +
Evans FO Jr, Sydnor JB, Moore WE, et al.  Sinusitis of the maxillary antrum. N Engl J Med . 1975;;293: 735-739.
9 +
Hamory BH, Sande MA, Sydnor A Jr, Seale DL, Gwaltney JM Jr.  Etiology and antimicrobial therapy of acute maxillary sinusitis. J Infect Dis . 1979;;139: 197-202.
10 +
Berg O, Carenfelt C.  Etiological diagnosis in sinusitis: ultrasonography as clinical complement. Laryngoscope . 1985;;95:851-853.
11 +
Shapiro GG, Furukawa CT, Pierson WE, Gilbertson E, Bierman CW.  Blinded comparison of maxillary sinus radiography and ultrasound for diagnosis of sinusitis. J Allergy Clin Immunol . 1986;; 77:59-64.
12 +
Rohr AS, Spector SL, Siegel SC, Katz RM, Rachelefsky GS.  Correlation between A-mode ultrasound and radiography in the diagnosis of maxillary sinusitis. J Allergy Clin Immunol . 1986;;78: 58-61.
13 +
Unger JM, Shaffer K, Duncavage JA.  Computed tomography in nasal and paranasal sinus disease. Laryngoscope . 1984;;94:1319-1324.
14 +
Havas TE, Motbey JA, Gullane PJ.  Prevalence of incidental abnormalities on computed tomographic scans of the paranasal sinuses. Arch Otolaryngol Head Neck Surg . 1988;;114:856-859.
15 +
Guyton AC. Textbook of Medical Physiology . Philadelphia, Pa: WB Saunders Co; 1986;:477.
16 +
Hollinshead WH, Rosse C. Textbook of Anatomy . Philadelphia, Pa: Harper & Row; 1985;:982.
17 +
Carson JL, Collier AM, Hu SS.  Acquired ciliary defects in nasal epithelium of children with acute viral upper respiratory infections. N Engl J Med . 1985;;312: 463-468.
18 +
Burtoff S.  Evaluation of diagnostic methods used in cases of maxillary sinusitis, with a comparative study of recent therapeutic agents employed locally. Arch Otolaryngol Head Neck Surg . 1947;; 45:516-542.
19 +
Loyal V, Jones J, Noyek A.  Management of odontogenic maxillary sinus disease. Otolaryngol Clin North Am . 1976;;9:213-222.
20 +
Williams JW Jr, Simel DL, Roberts L, Samsa G.  Clinical evaluation for sinusitis: making the diagnosis by history and physical examination. Ann Intern Med . 1992;;117:705-710.
21 +
Sackett DL.  A primer on the precision and accuracy of the clinical examination. JAMA . 1992;;267: 2638-2644.
22 +
Rachelefsky GS, Spector SL.  Sinusitis and asthma. J Asthma . 1990;;27:1-3.
23 +
Axelsson A, Runze U.  Symptoms and signs of acute maxillary sinusitis. ORL J Otorhinolaryngol Relat Spec . 1976;;38:298-308.
24 +
van Duijn NP, Brouwer HJ, Lamberts H.  Use of symptoms and signs to diagnose maxillary sinusitis in general practice: comparison with ultrasonography. BMJ . 1992;;305:684-687.
25 +
Swischuk LE, Hayden CK Jr, Dillard RA.  Sinusitis in children. Radiographics . 1982;;2:241-252.
26 +
Wald ER, Milmoe GJ, Bowen A, Ledesma-Medina J, Salamon N, Bluestone CD.  Acute maxillary sinusitis in children. N Engl J Med . 1981;;304:749-754.
27 +
McClean DC.  Sinusitis in children: lessons from twenty-five patients. Clin Pediatr . 1970;;9:342-345.
28 +
Kogutt MS, Swischuk LE.  Diagnosis of sinusitis in infants and children. Pediatrics . 1973;;52:121-124.
29 +
McNeill RA.  Comparison of the findings on transillumination, x-ray and lavage of the maxillary sinus. J Laryngol Otol . 1963;;77:1009-1013.
30 +
Gwaltney JM Jr, Sydnor A Jr, Sande MA.  Etiology and antimicrobial treatment of acute sinusitis. Ann Otol Rhinol Laryngol Suppl . 1981;;90:68-71.
31 +
Ballantyne JC, Rowe AR.  Some points in the pathology, diagnosis and treatment of chronic maxillary sinusitis. J Laryngol Otol . 1949;;63:337-341.
32 +
Otten FWA, Grote JJ.  The diagnostic value of transillumination for maxillary sinusitis in children. Int J Pediatr Otorhinolaryngol . 1989;;18:9-11.
33 +
Voltolini FER.  Die ersten Operationen in der Kehlkopfshohle vom Munde aus, bei der Durchleuchtung des Kehlkopfes von aussen. Dtsch Med Wochenschr . 1889;;15:340-343.
34 +
Smith MEN.  Sinus transillumination: an archaic survival. J Laryngol Otol . 1961;;75:93-94.
35 +
Berg O, Carenfelt C.  Analysis of symptoms and clinical signs in the maxillary sinus empyema. Acta Otolaryngol (Stockh) . 1988;;105:343-349.
36 +
Simel DL, Feussner JR, DeLong ER, Matchar DB.  Intermediate, indeterminate, and uninterpretable diagnostic test results. Med Decis Making . 1987;; 7:107-114.
37 +
Berg O, Bergstedt H, Carenfelt C, Lind MG, Perols O.  Discrimination of purulent from nonpurulent maxillary sinusitis: clinical and radiographic diagnosis. Ann Otol Rhinol Laryngol . 1981;;90:272-275.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
National Center for Health Statistics. National Ambulatory Medical Care Survey of Office Visits to General and Family Practitioners, January-December 1975. Advance data, No. 15; 1977.
2 +
MacKay I, ed. Rhinitis: Mechanisms and Management . Park Ridge, NJ: Parthenon Publishing; 1989;:169.
3 +
Simon HB.  Approach to the patient with sinusitis.  In: Goroll AH, May LA, Mulley AG, eds. Primary Care Medicine: Office Evaluation of the Adult Patient . Philadelphia, Pa: JB Lippincott; 1987;:883-885.
4 +
Axelsson A, Chidekel N, Grebelius N, Jensen C.  Treatment of acute maxillary sinusitis: a comparison of four different methods. Acta Otolaryngol (Stockh) . 1970;;70:71-76.
5 +
Wald ER, Chiponis D, Ledesma-Medina J.  Comparative effectiveness of amoxicillin and amoxicillin-clavulanate potassium in acute paranasal sinus infections in children: a double-blind, placebo-controlled trial. Pediatrics . 1986;;77:795-800.
6 +
Williams JW Jr, Roberts L, Distell B, Simel DL.  Diagnosing sinusitis by x-ray: comparing a single Waters view to 4-view paranasal sinus radiographs. J Gen Intern Med . 1992;;7:481-485.
7 +
Hayward MW, Lyons K, Ennis WP, Rees J.  Radiography of the paranasal sinuses: one or three views? Clin Radiol . 1990;;41:163-164.
8 +
Evans FO Jr, Sydnor JB, Moore WE, et al.  Sinusitis of the maxillary antrum. N Engl J Med . 1975;;293: 735-739.
9 +
Hamory BH, Sande MA, Sydnor A Jr, Seale DL, Gwaltney JM Jr.  Etiology and antimicrobial therapy of acute maxillary sinusitis. J Infect Dis . 1979;;139: 197-202.
10 +
Berg O, Carenfelt C.  Etiological diagnosis in sinusitis: ultrasonography as clinical complement. Laryngoscope . 1985;;95:851-853.
11 +
Shapiro GG, Furukawa CT, Pierson WE, Gilbertson E, Bierman CW.  Blinded comparison of maxillary sinus radiography and ultrasound for diagnosis of sinusitis. J Allergy Clin Immunol . 1986;; 77:59-64.
12 +
Rohr AS, Spector SL, Siegel SC, Katz RM, Rachelefsky GS.  Correlation between A-mode ultrasound and radiography in the diagnosis of maxillary sinusitis. J Allergy Clin Immunol . 1986;;78: 58-61.
13 +
Unger JM, Shaffer K, Duncavage JA.  Computed tomography in nasal and paranasal sinus disease. Laryngoscope . 1984;;94:1319-1324.
14 +
Havas TE, Motbey JA, Gullane PJ.  Prevalence of incidental abnormalities on computed tomographic scans of the paranasal sinuses. Arch Otolaryngol Head Neck Surg . 1988;;114:856-859.
15 +
Guyton AC. Textbook of Medical Physiology . Philadelphia, Pa: WB Saunders Co; 1986;:477.
16 +
Hollinshead WH, Rosse C. Textbook of Anatomy . Philadelphia, Pa: Harper & Row; 1985;:982.
17 +
Carson JL, Collier AM, Hu SS.  Acquired ciliary defects in nasal epithelium of children with acute viral upper respiratory infections. N Engl J Med . 1985;;312: 463-468.
18 +
Burtoff S.  Evaluation of diagnostic methods used in cases of maxillary sinusitis, with a comparative study of recent therapeutic agents employed locally. Arch Otolaryngol Head Neck Surg . 1947;; 45:516-542.
19 +
Loyal V, Jones J, Noyek A.  Management of odontogenic maxillary sinus disease. Otolaryngol Clin North Am . 1976;;9:213-222.
20 +
Williams JW Jr, Simel DL, Roberts L, Samsa G.  Clinical evaluation for sinusitis: making the diagnosis by history and physical examination. Ann Intern Med . 1992;;117:705-710.
21 +
Sackett DL.  A primer on the precision and accuracy of the clinical examination. JAMA . 1992;;267: 2638-2644.
22 +
Rachelefsky GS, Spector SL.  Sinusitis and asthma. J Asthma . 1990;;27:1-3.
23 +
Axelsson A, Runze U.  Symptoms and signs of acute maxillary sinusitis. ORL J Otorhinolaryngol Relat Spec . 1976;;38:298-308.
24 +
van Duijn NP, Brouwer HJ, Lamberts H.  Use of symptoms and signs to diagnose maxillary sinusitis in general practice: comparison with ultrasonography. BMJ . 1992;;305:684-687.
25 +
Swischuk LE, Hayden CK Jr, Dillard RA.  Sinusitis in children. Radiographics . 1982;;2:241-252.
26 +
Wald ER, Milmoe GJ, Bowen A, Ledesma-Medina J, Salamon N, Bluestone CD.  Acute maxillary sinusitis in children. N Engl J Med . 1981;;304:749-754.
27 +
McClean DC.  Sinusitis in children: lessons from twenty-five patients. Clin Pediatr . 1970;;9:342-345.
28 +
Kogutt MS, Swischuk LE.  Diagnosis of sinusitis in infants and children. Pediatrics . 1973;;52:121-124.
29 +
McNeill RA.  Comparison of the findings on transillumination, x-ray and lavage of the maxillary sinus. J Laryngol Otol . 1963;;77:1009-1013.
30 +
Gwaltney JM Jr, Sydnor A Jr, Sande MA.  Etiology and antimicrobial treatment of acute sinusitis. Ann Otol Rhinol Laryngol Suppl . 1981;;90:68-71.
31 +
Ballantyne JC, Rowe AR.  Some points in the pathology, diagnosis and treatment of chronic maxillary sinusitis. J Laryngol Otol . 1949;;63:337-341.
32 +
Otten FWA, Grote JJ.  The diagnostic value of transillumination for maxillary sinusitis in children. Int J Pediatr Otorhinolaryngol . 1989;;18:9-11.
33 +
Voltolini FER.  Die ersten Operationen in der Kehlkopfshohle vom Munde aus, bei der Durchleuchtung des Kehlkopfes von aussen. Dtsch Med Wochenschr . 1889;;15:340-343.
34 +
Smith MEN.  Sinus transillumination: an archaic survival. J Laryngol Otol . 1961;;75:93-94.
35 +
Berg O, Carenfelt C.  Analysis of symptoms and clinical signs in the maxillary sinus empyema. Acta Otolaryngol (Stockh) . 1988;;105:343-349.
36 +
Simel DL, Feussner JR, DeLong ER, Matchar DB.  Intermediate, indeterminate, and uninterpretable diagnostic test results. Med Decis Making . 1987;; 7:107-114.
37 +
Berg O, Bergstedt H, Carenfelt C, Lind MG, Perols O.  Discrimination of purulent from nonpurulent maxillary sinusitis: clinical and radiographic diagnosis. Ann Otol Rhinol Laryngol . 1981;;90:272-275.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...

JAMAevidence
© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems