Diagnosing Chronic Fatigue? Check For Sinusitis

Sinus disease is seldom considered as a cause of unexplained chronic fatigue or pain, despite recent ear, nose, and throat (otolaryngology) studies documenting significant fatigue and pain in patients with sinusitis and dramatic improvement after sinus surgery. A Harvard study showed that fatigue and pain scores of sinusitis patients were similar or worse than a group 20 years older with congestive heart failure, lung disease, or back pain.

"Chronic fatigue is a condition that frustrates both doctors and their patients since treatments directed at just the symptoms without knowing the cause are typically ineffective," said Alexander C. Chester, M.D., clinical professor of medicine at Georgetown University Medical Center and principal investigator of the pilot study. "While sinusitis will not be the answer for everyone who comes to an internist with unexplained fatigue or pain, this study does suggest that it should be considered as part of a patient's medical evaluation."

Through his private internal medicine practice, Chester questioned 297 patients, noting unexplained chronic fatigue in 22%, unexplained chronic pain in 11%, and both in 9%. While these numbers are consistent with previous studies, Chester observed an unusual connection between patients with chronic pain or fatigue: prevalent sinus symptoms. Sinus symptoms were nine times more common on average in patients with unexplained chronic fatigue than the control group, and six times more common in patients with unexplained chronic pain. In addition, sinus symptoms were more common in patients with unexplained fatigue than in patients with fatigue explained by a mental or physical illness, suggesting the syndrome of unexplained fatigue is more closely associated with sinusitis than are other types of fatigue.

The CDC approximates that sinusitis affects 32 million Americans. Rates are highest among women and people living in the South. Women comprised 46% of the participants in this study, but represented 60% of the group with fatigue, predominance also noted in most prior studies.

15 out of the 65 patients in Chester's study met criteria for chronic fatigue syndrome (CFS), a severe form of unexplained chronic fatigue associated with body pains and other symptoms. Most CFS patients had sinus symptoms and many noted a sudden onset of their illness, similar to people with sinusitis.

"We clearly need to do more research to see if sinus treatments alleviate fatigue and pain. This study does, however, offer hope for possible help in the future." said Chester.

Georgetown University Medical Center is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through our partnership with MedStar Health). Our mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis--or "care of the whole person." The Medical Center includes the School of Medicine and the School of Nursing and Health Studies, both nationally ranked, and the world renowned Lombardi Cancer Center.