Abstract
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.
Similar content being viewed by others
References
Woodwell DA, Cherry DK. Hea: National Ambulatory Medical Care Survey 2002 summary. Advance Data from Vital and Health Statistics. Number 346, August 26, 2004.
Low DE, Desrosiers M, McSherry J, et al. A practical guide for the diagnosis and treatment of acute sinusitis. Can Med Assoc J. 1997;156(Suppl 6):S1-S14.
Engels EA, Terrin N, Barza M, Lau J. Meta-analysis of diagnostic tests for acute sinusitis. J Clin Epidemiol. 2000;53:852–62.
Williams JW, Simel DL, Roberts L, Samsa GP. Clinical evaluation for sinusitis. Making the diagnosis by history and physical examination. Ann Intern Med. 1992;117:705–10.
Stammberger H. Functional Endoscopic Sinus Surgery: The Messerklinger Technique. Philadelphia: B.C. Decker; 1991.
Davidson TM. Clinical Manual of Otolaryngology. 2nd ed. New York: McGraw-Hill, Health Professions Division; 1992.
Evans FO, Sydnor JB, Moore WE, et al. Sinusitis of the maxillary antrum. N Engl J Med. 1975;293:735–9.
Davidson TM, Murphy C. Rapid clinical evaluation of anosmia. The alcohol sniff test. Arch Otolaryngol Head Neck Surg. 1997;123:591–4.
Gwaltney JM, Phillips CD, Miller RD, Riker DK. Computed tomographic study of the common cold. N Engl J Med. 1994;330:25–30.
Simel DL, Samsa GP, Matchar DB. Likelihood ratios with confidence: sample size estimation for diagnostic test studies. J Clin Epidemiol. 1991;44:763–70.
Author information
Authors and Affiliations
Corresponding author
Additional information
None of the authors have any conflicts of interest to declare.
This study is the result of work supported with resources and the use of facilities at the VA San Diego Healthcare System.
Rights and permissions
About this article
Cite this article
Thomas, C., Aizin, V. Brief report: A red streak in the lateral recess of the oropharynx predicts acute sinusitis. J GEN INTERN MED 21, 986–988 (2006). https://doi.org/10.1007/BF02743149
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02743149