Acute rhinosinusitis – are we forgetting the possibility of a dental origin? A retrospective study of 385 patients

Abstract

Background: Odontogenic sinusitis (OS) is a common but underdiagnosed form of acute rhinosinusitis (ARS). OS carries no specific characteristics, but unilateral symptoms and certain microbiological as well as radiological findings indicate odontogenic origin.

Aims/objectives: We studied the proportion of OS in ARS patients, the presence and associations of unilateral symptoms, and possible OS microbial and radiological findings. In addition, we investigated how this condition is recognised among ear, nose and throat specialists and radiologists.

Materials and methods: All 676 ARS patients treated in the Department of Otorhinolaryngology at Helsinki University Hospital in 2013 were retrospectively enrolled. The data were collected from patients’ hospital medical records, the laboratory database and radiological reports.

Results: Odontogenic origin of ARS was suspected in 59 (15.3%) patients. Altogether (29.9%) 115 patients complained of unilateral symptoms and these were found to associate with probable oral microbial findings (p < .001). These findings covered 20.2% of isolates. Teeth were mentioned in 89.6% of the radiological reports.

Conclusions and significance: OS is common among patients with ARS, and good diagnostic tools already exist in routine practice. Microbial and radiological findings should be carefully evaluated, especially in cases of unilateral symptoms.

背景：牙源性鼻窦炎（OS）是一种常见但未被诊断的急性鼻窦炎（ARS）。 OS没有特定的特征, 但单侧症状和某些微生物学以及放射学检查结果表明其牙源性病因。

目的：我们研究了ARS患者中OS的比例, 单侧症状的存在和相关性, 以及可能的OS微生物和放射学检测。此外, 我们调查了耳鼻喉科专家和放射科医师是如何识别这种病症的。

材料和方法：对所有2013年在赫尔辛基大学医院耳鼻喉科接受治疗的676例ARS患者进行了回顾性研究。数据来自患者的医院病历、实验室数据库和放射学报告。

结果：59例（15.3％）患者疑有ARS牙源性病因。共有115名患者（29.9％）抱怨单侧症状, 这些症状与检测出的可能的口腔微生物相关（p <.001）。这些发现涵盖了20.2％的分离株。在89.6％的放射学报告中提到了牙齿。

结论和意义：在ARS患者中OS很常见。在常规医疗实践中已经有良好的诊断方法。应仔细评估微生物和放射学检查结果, 对于单侧症状病例尤为如此。

Keywords:

• sinusitis
• maxillary sinus
• paranasal sinuses
• diagnosis
• periapical diseases
• dental pulp diseases
• iatrogenic disease

Acknowledgements

The statistical analysis was performed by statistician Tero Vahlberg, and we thank adjunct professor Tuomas Klockars for his help in revising the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Helsinki University Hospital Research Fund.