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Rapid diagnosis of bacterial sinusitis in patients using a simple test of nasal secretions

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Upper respiratory symptoms and sinusitis constitute a major reason for patient visits to their physician. The diagnosis of sinusitis is often made based on history and physical exam, but the accuracy of such diagnosis is questioned. Sinus films or CT scans are expensive. Obtaining pus from the middle meatus is impractical. We studied whether analysis of four easily measured substances (protein, pH, leukocyte esterase and nitrite) in nasal secretions could predict the presence or absence of bacterial sinusitis, as diagnosed by history combined with sinus x ray or CT. We enrolled 217 consecutive patients, aged 4‐61 years, with clinically suspected bacterial sinusitis (duration of symptoms, 7‐26 days), who had radiographic studies. All had their nasal secretions assayed using a simple rapid test. A clinical scoring system was developed to allow for a simple interpretation of test results of four assays in a single clinical score. All 52 patients with scores of 0 or 1 were CT or x-ray negative for bacterial sinusitis. All 144 with scores of ≥4 were imaging study positive. Of the 21 patients (10%) with scores of 2 or 3, 14 were imaging study negative and 7 were positive. We concluded that combining these four separate assays on nasal secretion into one number, it is possible to rule in or rule out bacterial sinusitis in 90% of patients. This inexpensive, simple test can decrease the cost and help increase the accuracy of the diagnosis, thus improving the care of patients with bacterial sinusitis.
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Keywords: Bacterial sinusitis; CT; chemical assay; clinical scores; diagnosis; leukocyte esterase; nasal secretion; pH; protein; rapid

Document Type: Original Article

Affiliations: Division of Pulmonology and Allergy, Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA. [email protected]

Publication date: November 1, 2008

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma and by having the potential to directly impact the quality of patient care. AAP welcomes the submission of original works including peer-reviewed original research and clinical trial results. Additionally, as the official journal of the Eastern Allergy Conference (EAC), AAP will publish content from EAC poster sessions as well as review articles derived from EAC lectures.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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