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September 13, 2000

Diagnosis and Treatment of Recurrent Sinusitis—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(10):1240. doi:10.1001/jama.284.10.1239

In Reply: The diagnosis of recurrent bacterial sinusitis in Mr S was well established based on history but was not fully delineated in the article. The patient had no history of smoking or of intranasal drug use other than topical nasal steroids. There were no environmental exacerbating factors (other than flying) and no children in day care. Gastrointestinal reflux is not established as a cause of rhinosinusitis, and there was no evidence of velopharyngeal incompetence. However, as mentioned in the article, some additional diagnostic studies would indeed be beneficial. Nasal endoscopy performed between, rather than during, an acute attack might help confirm inflammation persisting between episodes. Although an immunologic deficit is an uncommon cause of isolated recurrent sinusitis, I noted that it would be prudent to evaluate for this possibility. However, the presence of an immunologic deficit would not necessarily change the proposed therapeutic intervention.