Brief report: A red streak in the lateral recess of the oropharynx predicts acute sinusitis

• Published in: Journal of general internal medicine : JGIM Vol. 21; no. 9; pp. 986 - 988
• Main Authors: Thomas, Colin, Aizin, Vitali
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01.09.2006; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Antibiotics; Biological and medical sciences; Confidence intervals; Female; General aspects; Hospitals, Veterans; Humans; Internal medicine; Likelihood Functions; Male; Medical diagnosis; Medical sciences; Middle Aged; Oropharynx - diagnostic imaging; Oropharynx - pathology; Otorhinolaryngology. Stomatology; Predictive Value of Tests; Sinuses; Sinusitis - diagnosis; Sinusitis - diagnostic imaging; Tomography, X-Ray Computed; Transillumination - methods; United States; Acute; Prediction; physical examination; Oropharynx; Sinusitis; Medicine; symptoms; Symptomatology; Sensitivity; Specificity; signs; ENT disease; Paranasal sinus disease; Clinical investigation; Predictive factor; Semiology
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/BF02743149

To evaluate the oropharyngeal red streak sign for diagnosing acute sinusitis. Exploratory cohort study. A Veterans Affairs medical center urgent care center. Sixty consecutive subjects presenting with nasal symptoms lasting 4 weeks or less. 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. 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.