Evaluation of chronic cough in pulmonary practice often requires either empiric trials of therapy or testing. The prevalence of chronic sinusitis and the role of CT sinus is debated, with some suggesting it has no role, and others suggesting that it may be a useful test late in an algorithmic approach. Previous recommendations have been based on relatively small series of patients. We wished to evaluate the role of CT sinus in our tertiary referral chronic cough practice.
Retrospective review of chronic cough registry data.
CT sinus was obtained in 159 (22.6%) patients referred for chronic cough. Obtaining a CT was far more common among those with abnormal ENT physical exam findings (31% of 702, p<0.0001). When chronic rhinosinusitis was suspected clinically, the CT sinus was abnormal in 123 (77.4%). An abnormal CT findings was not significantly associated with abnormal ENT exam (p=0.5782). Fluid levels indicating acute sinusitis was present in 51 (32%), and again, an abnormal ENT exam was not predictive of acute sinusitis (p=0.0833).
Nearly three-quarters of patients who underwent CT for a clinical suspicion of rhinosinusitis had and abnormal CT and nearly one third had acute sinusitis. Physical exam was not predictive of acute or chronic sinus findings. It follows that occult sinus disease likely plays a significant role in many patients with chronic cough referred to a tertiary cough clinic.
. In the absence of other explanations for chronic cough on initial evaluation, sinus CT should be considered.
Kaiser Lim, None.