Clinical versus radiological pointers of maxillary sinusitis in performing an aspirate in patients with fever of more than 10 days

ABSTRACT

The value of a diagnostic maxillary sinus aspirate in patients with fever of more than ten days with abnormal sinus x-ray findings is unclear. When the intrinsic medical side fails to find a cause for such a prolonged fever, after consuming all tests, yet finds suspicious sinus radiological changes, he will consider the otolaryngologist to lend a hand in aspirating the sinus for bacteriological examination. It is a well-known fact that maxillary sinus aspirate is a surgical procedure that is not risk free, besides its discomfort and invasiveness to the patient. Therefore, this procedure is not to be performed lightly for febrile patients with not rigid indications for applying it. This study was conducted to find out how significantly can the otolaryngologist relay upon the clinical signs and symptoms pointing towards an underlying sinus infection and not depending on sinus radiological changes in performing the procedure. Both the otolaryngologist and the intrinsic medical sides participated in this study. To start with, the medical side while investigating febrile subjects, running fever for more than ten days and failing to find a cause through the laboratory tests, but ending with a positive finding on sinus x-ray which could point to a possible underlying infection causing the fever. This is where such a patient was referred to the ENT side to participate in tackling the case. A careful history was collected along with a thorough examination. The radiological study was carefully interpreted and the findings recorded. The 51 maxillary sinus aspirate samples collected from 34 patients were sent for bacteriological culture. 86.4% of patients with a positive history of sinus and nasal symptoms yielded positive cultures, whereas only 8.3% with radiological changes and no symptoms of sinusitis had a positive culture. This study indicates that the symptoms of sinus disease in the febrile patient's history are the reliable parameter in directing the otolaryngologist in deciding upon a maxillary sinus aspirate, once those patients have a positive radiological change marking the possibility of a sinus cause for the fever