The role of sinus imaging in the treatment of chronic cough in adults

Primary study objective: To determine the appropriate role and timing of si nus imaging studies in the evaluation and treatment of chronic cough. Design: Prospective study of chronic cough. All patients underwent sinus im aging, the results of which identified prospectively the following: (1) flu id in sinuses, with or without opacification, and (2) mucosal thickening. P atients then were treated using an algorithm that sequentially addresses th e etiologies of chronic cough. Patients whose sinus imaging studies had dem onstrated fluid were treated initially for sinusitis, but mucosal abnormali ties alone were not considered an indication to change the algorithm. after workup, relationships between abnormalities on sinus imaging studies and d iagnoses were determined. Setting: University hospital pulmonary outpatient clinic. Patients: Thirty-six patients (31 women, 5 men; mean age, 58.4 years). Coug h duration averaged 5.2 years (range, 4 weeks to 30 years). Results: Diagnoses were made in 100% of patients, and cough resolved in 86% . Mucosal thickening correlated with sinusitis as a cause of cough in only 29% of cases. Conclusions: Mucosal thickening is not diagnostic of sinusitis as a cause o f chronic cough; in most patients, cough will resolve without treatment for sinusitis. Given this lack of specificity, it is reasonable to delay sinus imaging until after efforts at treating rhinitis have failed and, in the a bsence of complaint or findings of postnasal drip, until after completion o f evaluation for asthma. The principles of diagnosis and treatment of chron ic cough remain simple: go sequentially from the most common to the least c ommon cause; use tools that begin with the most available and least expensi ve and invasive modality; then move as needed to tools that are more expens ive and invasive.