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September 8, 1993

Does This Patient Have Sinusitis?Diagnosing Acute Sinusitis by History and Physical Examination

Author Affiliations

From the Division of General Internal Medicine, University of Texas Health Sciences Center at San Antonio, and the Ambulatory Care Service, Audie L. Murphy Memorial Veterans' Hospital, San Antonio, Tex (Dr Williams); and the Ambulatory Care Service and The Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, and the Division of General Internal Medicine, Duke University Medical Center, Durham, NC (Dr Simel).

JAMA. 1993;270(10):1242-1246. doi:10.1001/jama.1993.03510100092039


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