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A Pilot Study

Alexander C. Chester, MD

Arch Intern Med. 2003;163:1832-1836.

Background  Recent otolaryngologic studies document significant fatigue and bodily pain (BP) in patients with chronic rhinosinusitis. Studies of general medical patients are lacking.

Methods  A case-control study of 297 consecutive general medical outpatients.

Results  Sixty-five patients noted unexplained chronic fatigue (UCF), 33 reported BP, and 26 had both. Compared with 232 patients without UCF, patients with UCF more frequently had the following rhinosinusitis symptoms: facial pressure (odds ratio [OR], 9.7; 95% confidence interval [CI], 5.2-18.2), heavy-headedness (OR, 21.9; 95% CI, 10.9-44.0), nasal obstruction (OR, 4.3; 95% CI, 2.3-7.9), frontal headache (OR, 13.6; 95% CI, 6.5-28.5), postnasal drip (OR, 2.8; 95% CI, 1.6-5.0), sore throat (OR, 3.1; 95% CI, 1.5-6.6), and tender cervical lymph nodes (OR, 9.2; 95% CI, 4.3-19.7). A similar predominance of rhinosinusitis symptoms was noted in patients with BP and in 15 patients with UCF who had chronic fatigue syndrome. No increased prevalence of pollen allergy was noted in association with UCF, BP, or chronic fatigue syndrome. Gastrointestinal, sleep, and psychiatric problems were similar between patients with UCF and 38 patients with explained fatigue. Rhinosinusitis symptoms, however, were more common in UCF.

Conclusions  There is an increased prevalence of rhinosinusitis symptoms but not pollen allergy among general medical outpatients with UCF, BP, or both. Rhinosinusitis symptoms are at least as common as gastrointestinal complaints, sleep disturbance, and psychiatric problems (previously well documented complaints associated with UCF and BP). Rhinosinusitis symptoms, furthermore, are more common in UCF than in fatigue explained by a physical or mental illness.

From the Department of Medicine, Georgetown University Medical Center, Washington, DC. The author has no relevant financial interest in this article.