Physicians, Patients Differ in Descriptions of Sinus Infection

Brandon May

August 12, 2022

A new study published in the International Forum of Allergy & Rhinology suggests that patients and physicians have differing views on what symptoms constitute a sinus infection, probably resulting in communication barriers between patients and providers and potential misunderstandings — including misdiagnoses — in the clinic.

The study findings were derived from responses to a semantic-based questionnaire administered to 560 patients (54.4% female; mean age, 48.9 years) upon arrival to tertiary otolaryngology clinics between 2020 and 2021.

The survey included 28 words and phrases from which the patient could choose to answer, "What are the symptoms of a sinus infection?" Participants were also asked in the survey, "What is meant by the word 'sinus?'"

To determine differences in definitions of sinus infection between patients and clinicians, 29 otolaryngologists (42% female; mean age, 37.4 years) were also provided the survey to complete during a departmental academic conference.

Patients and clinicians most often selected mucus symptoms to describe a sinus infection. The most frequently selected symptom categories to describe sinus infections among patients included mucus (89.3%), pressure/pain (85.7%), and airflow (83.6%). In contrast, clinicians most often selected the symptom categories of pressure/pain (14.3% difference; 95% CI, 7.6%-22.5%), mucus (10.7% difference; 95% CI, 4.7%-18.3%), and airflow (13.0% difference; 95% CI, 4.8%-21.7%).

The investigators indicated that otolaryngologists appear to "focus more narrowly on sinus infection symptoms localized to the sinuses" to define sinus infection and are much less likely than patients to consider systemic or regional complaints.

Commenting on the study, Matthew A. Tyler, MD, an assistant professor in rhinology and endoscopic skull base surgery at the University of Minnesota Medical School, told Medscape Medical News that the miscommunication of symptoms by patients to providers can lead to the initiation of inappropriate treatments and most commonly overprescription of antibiotics.

"Patients may perceive a substantial amount of mucus or facial pain as a sinus infection, and the expectation there is that they will get some sort of treatment," explained Tyler, who was not involved in the study. "I think sometimes in healthcare you try to deliver toward an expectation, and sometimes that's overprescribing antibiotics."

Tyler added that the overprescribing of antibiotics may increase the risk for antibiotic resistance and indicated that these therapies can also have negative side effects, causing undue burden among patients. "If patients are able to better communicate their symptoms and self-identify and describe their symptoms, I think it can go a long way toward mitigating costs and the overprescription of antibiotics," he commented.

According to Tyler, primary care providers are often on the frontlines for patients presenting with symptoms of sinus infection and are therefore at increased need to better understand the symptoms necessary to make an appropriate clinical diagnosis.

"I think from a provider standpoint, just having better education on some of the very simple clinical factors that are needed to actually make a diagnosis of sinusitis can remove a lot of the noise that is associated with misdiagnosing in sinusitis and mistreating it as well," he said.

But there may be discord between patients and providers about the length of symptoms in defining a sinus infection, noted John M. James, MD, a medical specialist and spokesperson for the Asthma and Allergy Foundation of America, who was not involved with the study. "Typically, symptoms would be present for about 10 days before a sinus infection would be diagnosed," he explained in an email to Medscape.

James added that healthcare providers should take the time to explain to the patient what sinusitis is and spend time educating the patient on the presenting clinical symptoms and therapies, including when antibiotics are indicated and when they are not, as well as appropriate follow-up.

"If the patient and provider understand each other and are 'on the same page' in terms of the diagnosis and management of sinusitis, patient outcomes will improve," he stated.

Tyler and James report no relevant financial relationships. The study received no commercial or financial grant/assistance from industry.

Int Forum Allergy Rhinol. Published online July 16, 2022. Abstract

Brandon May is a freelance medical journalist who has written more than 2100 articles for medical publications in the United States and the UK. Twitter: @brandonmilesmay

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