Does This Patient Have Sinusitis?

Abstract

To the Editor. —The article on sinusitis by Williams and Simel1is a valuable contribution, but the authors overstate their case in two areas. First, they cite two studies of maxillary sinusitis2,3to support their claim that randomized trials have shown that sinusitis antibiotics for rapid resolution. The word requires is too strong here, since a majority of untreated subjects in both studies were improved or cured at 10 days. Moreover, one was a pediatric study that may not be applicable to adults.2The other was an adult study with methodologic weaknesses.3A primary end point was subjective improvement, but patients and investigators were not blinded to treatment; and the nasal decongestant only group had more bilateral sinusitis and completely opacified sinuses than the lincomycin group, suggesting that more complicated cases might have been assigned to the no-antibiotic group. Interestingly, an authority cited by Williams