The Common Cold in Patients with a History of Recurrent Sinusitis Increased Symptoms and Radiologic Sinusitislike Findings

Symptoms and Signs

Both the sinusitis-prone patients and the control patients had symptoms for an average of 3 days before day 1 (mean duration=3.0 days [standard deviation (SD) =1] and mean duration=3.2 days [SD=1], respectively). The control patients had markedly lower overall mean symptom scores than the sinusitis-prone patients (144 [SD=70] vs 177 [SD=74]; P=.04), the difference increasing during days 1 to 3 Figure 1. Facial pain was more common and more severe among the sinusitis-prone patients than among the control patients (73% [16] vs 24% [6]; P=.001 and median scores 5 [range 0-43] vs 0 [0-26]; P=.002), but the frequency and severity of the other symptoms were similar in the 2 groups (data not shown). On day 21, 2 sinusitis-prone patients (9%) and 4 control patients (16%) still reported symptoms.

The distributions of patients having various pathologic nasoendoscopic findings were similar in the sinusitis-prone group and the control group on day 1 Table 2. None of the pathologic nasoendoscopic findings correlated with the presence of facial pain. By day 21, the frequencies of pathologic nasoendoscopic findings had dropped similarly in the 2 groups.

Radiologic Findings

The sinusitis-prone patients had radiologic sinusitislike changes significantly more often both overall (65% [15] vs 36% [9], difference=29% [95% confidence interval (CI), 2%-56%]; P=.04) and in the maxillary sinus (56% [13] vs 28% [7]; P=.05) than the control patients on day 1 Table 2. In contrast, the distributions of patients having an air-fluid level or total opacification in any sinus were similar in the 2 groups. The symptom scores were similar for the patients with and without radiologic sinusitis in both groups (data not shown). On day 21, the proportions of patients with radiologic sinusitis had dropped, particularly in the sinusitis-prone group, and the 2 groups were similar. Of the 15 patients who had radiologic sinusitis on day 21, 7 (47%) had been given antibiotics and 6 (40%) still had acute symptoms, but these 2 factors were unrelated to each other (P=.20).

Microbiologic Findings

Viral etiology of the common cold was verified in 67% (32) of the patients Table 3. The proportions of sinusitis-prone patients and control patients with viral infection were similar (70% [16] vs 64% [16]; P=.68). The most frequent virus was rhinovirus, which was detected in 35% (8) and 20% (5) of the sinusitis-prone and control patients, respectively. The number of patients having pathogenic bacteria (Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis) isolated from the nasopharynx was significantly greater among the controls than the sinusitis-prone patients (40% [10] vs 9% [2], difference 31% [95% CI, 9%-54%]; P <.01). This same difference was also seen in the cultures taken from the middle meatus, although it was not statistically significant (24% [6] vs 9% [2]; P=.15, respectively). The nasopharyngeal culture findings of the smoking and nonsmoking patients were similar (19% [3] vs 31% [10]; P=.36, respectively). One control subject had a Fusobacterium species, but no other pathogenic anaerobic bacteria were found. The presence of either verified viral infection or pathogenic bacteria isolated from the nasopharynx was not related to radiologic sinusitislike changes in both groups (data not shown).

Treatment

Altogether 13 patients were considered to have bacterial sinusitis based on clinical and radiologic criteria, and 10 were given amoxycillin and 3 sulpha-trimethoprim. The sinusitis-prone patients were treated with antimicrobials more often than the control patients (43% [10] vs 12% [3]; P=.02). None of the patients consulted another physician or received any other prescription during the study. Two of the 10 sinusitis-prone patients and 2 of the 3 control patients considered to have bacterial sinusitis on the basis of the symptoms and signs and radiologic findings had pathogenic bacteria isolated from the nasopharynx. Thus, if a positive nasopharyngeal bacterial culture had been used as an additional criterion for antimicrobial treatment only 4 patients would have been treated.

Discussion

We found that the patients who had suffered from recurrent sinusitis episodes had significantly higher symptom scores and radiologic sinusitislike changes more often during an ordinary viral common cold than the patients who had never had sinusitis. The patients with a history of sinusitis also had more prolonged symptoms and more facial pain than did the control patients. The viral etiology of the common cold was verified in two thirds of the episodes, and it was similar in both groups. Yet, pathogenic bacteria were found rarely in the middle meatus especially among the sinusitis-prone patients.

We were unable to find any explanation for these differences in the symptom scores and radiologic findings between the sinusitis-prone and control patients during a common cold. It was not explained by allergy or the etiology of the infection. Also, symptom scores were not related to radiologic changes, which is in agreement with the results of an earlier study.⁸ Differing psychologic factors may also affect the symptom scores. Men have been shown to exaggerate their cold symptoms,⁹ and smoking has been found to predispose persons to common cold¹⁰; however, even these variables and other background characteristics were similar in our sinusitis-prone patients and control patients. Nonatopic nasal hyperreactivity and permanent mucosal changes in the nose and sinuses are other possible explanations for the differences.