Sinus Fatigue

A little less than 10 years ago a research project that I had been working on for many years was published in the Archives of Internal Medicine. The observation that propelled me into the relationship described in the article related to my first experiences as a clinician.

I was aware that sinusitis caused fatigue years before I became a doctor because of personal experience and conversations with others who also suffered from sinus problems. I was surprised that my own doctor seemed unaware of the association and I was surprised that fatigue was not listed as a symptom in the general medical texts that I searched in college.

Nothing changed in medical school. Although the lists of illnesses that caused fatigue was quite long, and the lectures on the subject quite thorough, no one that I can recall mentioned sinusitis as a cause of fatigue.

When I first started practice my experience confirmed my own observations that patients with sinusitis were fatigued but, again, a thorough search of the medical literature produced nothing. I then started noticing that patients with a primary complaint of fatigue often, on more detailed questioning, acknowledged sinus symptoms but considered the sinus issue quite minor compared to the more pressing complaint of fatigue.

After trying to redirect the focus towards the sinus issue and initiating treatment, patients would usually notice a great improvement in fatigue. Patients found this puzzling. In fact, often a patient would return months later with the primary complaint of serious fatigue completely having forgotten the link with sinusitis. Once again I would treat the sinusitis and the fatigue would remit.

In the late 1980s I began to see some notice in the medical literature. A consensus conference of ear, nose and throat physicians in 1987 described fatigue as one of the diagnostic criteria for making the diagnosis of chronic sinusitis. I reported several cases of patients diagnosed as having chronic fatigue syndrome who experienced a complete or nearly complete resolution of fatigue following sinus surgery.

Nothing on the subject was mentioned in the internal medicine literature, an unfortunate omission since internists are the doctors who treat fatigue.

I was curious about how common sinus problems are found in patients with a primary complaint of unexplained chronic fatigue. This is how the project unfolded.

I examined 297 consecutive patients who were younger than 41 years, administered a detailed questionnaire and performed a battery of screening laboratory tests. Young patients were chosen in an effort to exclude the illnesses of older age groups that might confound the results.

Of the 297 patients, 65 (22%) noted unexplained fatigue that has persisted for more than one month, fatigue unexplained by the lack of rest, illness, or undo physical or mental exertion. Fifteen (23%) of these patients met the diagnostic criteria for chronic fatigue syndrome, an illness characterized by prolonged and severe fatigue.

When the 65 patients with unexplained chronic fatigue were compared to the remaining group of 232 patients most sinus symptoms were much more common in the group with unexplained chronic fatigue: facial pressure (80% vs 13%), heavy-headedness (80% vs 8%), nasal obstruction (87% vs 42%), frontal headache (53% vs 6%), sore throat (33% vs 8%) and cervical node tenderness (60% vs 6%.)

Of note, symptoms usually associated with unexplained illnesses such as gastrointestinal problems, sleep disturbance, and psychiatric illness were similar in the group with unexplained chronic fatigue when compared to the group with fatigue explained by a physical or mental illness.  However, sinus symptoms were much more common in the former when compared to the latter.

The results confirmed my suspicion that there is a peculiar and predominant relationship between chronic sinusitis and unexplained fatigue.

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