Usual care and outcomes in patients with sinus complaints and normal results of sinus roentgenography

OBJECTIVE: To describe the usual care and outcomes of patients with sinus symptoms and normal sinus roentgenograms. DESIGN: Prospective cohort with 60-day follow-up. SETTING: Medical outpatient clinics at a university-affiliated Veterans Affairs medical center. PATIENTS: Consecutive patients (n = 126, 88% follow-up rate) with rhinorrhea (88%), facial pain (65%), or self-suspected sinusitis (24%) and normal four-view sinus roentgenography (median age, 47 years; 90% male; 56% white). MAIN OUTCOME MEASURE: Fourteen-day self-reported symptom status. RESULTS: Sixteen history and five physical examination items were recorded by clinicians who were blinded to the results of sinus roentgenography; clinical diagnoses and treatment plans were formulated by clinicians with knowledge of the results of sinus roentgenography. Clinical diagnoses included allergic rhinitis (27%), sinusitis (22%), viral respiratory tract infection (14%), and bronchitis (11%). Treatments included administration of antibiotics (40%), decongestants (32%), antihistamines (25%), and nasal steroids (9%). Forty-nine percent achieved 14-day clinical success (13.5% were cured and 36% were much improved). Improvement was more likely among patients who presented with cough (odds ratio, 3.0; 95% confidence interval, 1.3 to 6.9) but was less likely among those with itchy eyes (odds ratio, 0.18; 95% confidence interval, 0.07 to 0.43). Patients with cough and without itchy eyes had significantly shorter clinical courses (P = .003). Of patients who achieved clinical success on day 14, 30% relapsed or recurred by day 60. CONCLUSION: With usual medical care, the syndrome of sinus symptoms and normal results of sinus roentgenography persists for at least 14 days in many patients; however, patients with cough but without itchy eyes may have shorter clinical courses.