Sinusitis in the common cold

Abstract

Background: Acute community-acquired sinusitis is considered a bacterial complication of the common cold. Radiologic abnormalities in sinuses occur, however, in most patients with upper respiratory virus infections.

Objective: Assessment of the occurrence, clinical profile, laboratory findings, and outcome of radiologically confirmed sinusitis was carried out as part of a common cold study in young adults.

Methods: Clinical examinations and radiography of the paranasal sinuses were carried out on days 1, 7, and 21 in 197 patients with the common cold. The symptoms were recorded on diary cards on days 1 to 20. Ten viruses and 5 bacteria were studied as etiologic agents of common cold as reported earlier. Serum C reactive protein concentrations, erythrocyte sedimentation rates, and total white blood cell counts with differentials were determined in 40 randomized subjects on day 7. The effect of 6 days of intranasal fluticasone propionate treatment of the common cold in the prevention of sinusitis was analyzed.

Results: On day 7, 39% of patients with the common cold in the placebo group (n = 98) had sinusitis, which we would prefer to call viral sinusitis. The symptoms of patients with sinusitis and those without it were not clinically distinguishable. Viral infection was detected in 81.6% of patients with sinusitis. No significantly increased levels of antibodies to bacteria were detected. Serum C reactive protein concentrations, erythrocyte sedimentation rates, and white blood cell counts were low in patients with sinusitis. All patients made a clinical recovery within 21 days without antibiotic treatment. Fluticasone propionate treatment tended to prevent paranasal sinusitis, especially in rhinovirus-positive subjects.

Conclusion: Viral sinusitis frequently occurs in the early days of the common cold, but it is a self-limited illness. The sinuses should not be imaged in patients with the common cold if the signs and symptoms of illness gradually become less severe and no specific signs suggestive of bacterial sinusitis occur.

Fig. 1

A 23-year-old woman with rhinovirus-induced common cold and normal sinus radiograph on day 1 (A). On day 7 (B), the radiograph shows maxillary sinusitis (mucosal thickening over 5 mm in the right sinus), CRP less than 10 mg/L, ESR of 13 mm/hour, and WBC of 5.3 × 10⁹/L. Symptoms disappeared within 14 days after onset of illness. On day 21 (C), mucosal thickening has resolved, but minor air-fluid level is seen in right maxillary sinus.

Fig. 2

A 25-year-old woman with common cold. No virus was detected. Symptoms disappeared within 14 days after onset of illness. Air-fluid level was found in right frontal sinus on day 21. Follow-up radiograph was taken after 2 weeks and found to be normal. Subject was asymptomatic, and no treatment was given.