Chester, Alexander C · Archives of internal medicine · 2003 · DOI
This study looked at whether people with unexplained chronic fatigue or body pain experience more sinus and nasal symptoms than people without these conditions. Researchers compared 297 patients and found that those with unexplained fatigue were much more likely to report symptoms like facial pressure, headaches, nasal obstruction, and postnasal drip—but not allergies. This suggests that sinus problems may be connected to chronic fatigue in ways doctors haven't fully recognized.
This study highlights an underrecognized connection between rhinosinusitis symptoms and unexplained chronic fatigue, suggesting that doctors evaluating ME/CFS patients should consider sinus and nasal dysfunction as a potential contributing or associated factor. The findings challenge the assumption that fatigue and pain in these patients are primarily psychiatric or gastrointestinal in origin, pointing instead to an otolaryngologic component that deserves clinical attention.
This study does not prove that rhinosinusitis causes ME/CFS or unexplained fatigue, only that the symptoms co-occur more frequently than expected. The cross-sectional design prevents determination of temporal relationships or causality. Additionally, no objective imaging or endoscopic confirmation of sinusitis was performed, so the study relies on symptom reporting rather than clinical diagnosis.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Chester, Alexander C (2003). Symptoms of rhinosinusitis in patients with unexplained chronic fatigue or bodily pain: a pilot study.. Archives of internal medicine. https://doi.org/10.1001/archinte.163.15.1832
BibTeX
@article{mecfsatlas-chester-2003-symptoms-rhinosinusitis,
author = {Chester, Alexander C},
title = {Symptoms of rhinosinusitis in patients with unexplained chronic fatigue or bodily pain: a pilot study.},
journal = {Archives of internal medicine},
year = {2003},
doi = {10.1001/archinte.163.15.1832},
note = {PubMed: 12912720},
url = {https://www.mecfsatlas.com/evidence/chester-2003-symptoms-rhinosinusitis},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/chester-2003-symptoms-rhinosinusitis
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