ABSTRACT
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.
