Brief report: a red streak in the lateral recess of the oropharynx predicts acute sinusitis.

OBJECTIVE

To evaluate the oropharyngeal red streak sign for diagnosing acute sinusitis.

DESIGN

Exploratory cohort study.

SETTING

A Veterans Affairs medical center urgent care center.

PARTICIPANTS

Sixty consecutive subjects presenting with nasal symptoms lasting 4 weeks or less.

MEASUREMENTS AND MAIN

RESULTS

Each subject underwent a structured history and physical examination, followed by a sinus computed tomography (CT) scan. Acute sinusitis was defined by an air-fluid level or opacification of 1 or more sinuses on CT imaging. Twenty-seven subjects were diagnosed with sinusitis. A localized red streak in the lateral recess of the oropharynx was associated with sinusitis, with a positive likelihood ratio (LR+) and 95% confidence interval (CI) of 2.11 (1.23, 3.63) and a negative likelihood ratio (LR-) and 95% CI of 0.44 (0.24, 0.83). Opacity on maxillary or frontal sinus transillumination was also associated with sinusitis (LR+ of 1.89; CI 1.03, 3.32 and LR- of 0.56; CI 0.32, 0.96). Symptom duration > 10 days was associated with acute sinusitis with an LR+ of 1.89 (1.06, 3.59). A history of facial pain (LR+ of 0.59; CI 0.39, 0.90 and LR- of 2.85; CI 1.27, 6.41) and the finding of sinus percussion tenderness (LR+ of 0.22; CI 0.05, 0.90 and LR- of 1.88; CI 1.17, 3.03) were inversely associated with sinusitis.

CONCLUSIONS

The oropharyngeal red streak may be an accurate physical sign for diagnosing acute sinusitis. This sign should be included in future studies of clinical diagnostic criteria for acute sinusitis.