Diagnostic accuracy of acute maxillary sinusitis in adults in primary care.

OBJECTIVE

To evaluate the diagnostic value of symptoms and signs used in diagnosing acute community-acquired maxillary sinusitis (ACAMS), and to find useful clinical predictors for diagnosing it in adults in primary care.

DESIGN

Prospective study in the study group and retrospective study in the reference group.

SETTING

One primary care centre in the study group and another in the reference group.

SUBJECTS: 50 adults with prolonged upper respiratory tract infection > or = 7 days) or self-suspected maxillary sinusitis. As a reference group, an analysis of records and diagnoses made by GP of 45 adult patients with the same inclusion criteria from another primary care clinic.

MAIN OUTCOME MEASURES: The signs and symptoms associated with the diagnosis of ACAMS by GP and otorhinolaryngologist. The value of CRP, ultrasound and peak nasal expiratory flow in the diagnosis.

RESULTS

Neither ultrasound nor any of the clinical signs increased the accuracy of diagnosis. Peak nasal expiratory flow below the normal range was associated with the diagnosis of ACAMS (p = 0.03). The presence of an otorhinolaryngologist had an influence on GP practice when compared with the reference group.

CONCLUSION

The diagnosis of ACAMS is difficult with the available clinical methods. Peak nasal expiratory flow needs further study. New diagnostic means are needed.