Nasal polyposis and facial pain

Fahy, Colm; Jones, Nick

doi:10.1046/j.1365-2273.2001.00514.x

Cited by 50 publications

(37 citation statements)

References 24 publications

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“…Studies indicate that only 20% of patients who are referred to a rhinology clinic have pain that is actually attributable to sinusitis [11][12][13][14][15][16]. In our study, 68% of patients with a primary diagnosis of "sinus headache" had migraine and 27% had tension-type headache.…”

Section: Discussionmentioning

confidence: 51%

“…Therefore, many patients with headache or facial pain imagine they have a sinus problem or even have their symptoms mistakenly labeled as sinogenic pain by a general practitioner [10]. On the other hand, more than 80% of patients who have purulent rhinorrhea, the majority of patients with cases of sinonasal polyposis and children with chronic rhinosinusitis do not complain of facial pain or headache [10][11][12]. In addition, after endoscopic sinus surgery, a signiWcant proportion of candidates still complain of facial pain [11,13,14].…”

Section: Discussionmentioning

confidence: 99%

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Causes of headache in patients with a primary diagnosis of sinus headache

Foroughipour

Sharifian

Shoeibi

et al. 2011

Eur Arch Otorhinolaryngol

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Headache is a common occurrence among the general population. Although the pain could be a symptom of acute sinusitis, chronic sinusitis is not considered as a usual cause of headache. In addition, autonomic-related symptoms in the sinonasal region may be associated with vascular pain. Confusion regarding these symptoms could lead to an incorrect diagnosis of sinusitis. A prospective cross-sectional study was conducted at two tertiary referral centers with residency programs in otorhinolaryngology, head and neck surgery and neurology. The study included 58 patients with a diagnosis of "sinus headache" made by a primary care physician. Exclusion criteria were as follows: previous diagnosis of migraine or tension-type headache; evidence of sinus infection during the past 6 months; and the presence of mucopurulent secretions. After comprehensive otorhinolaryngologic and neurologic evaluation, appropriate treatment was started according to the final diagnosis and the patient was assessed monthly for 6 months. The final diagnoses were migraine, tension-type headache and chronic sinusitis with recurrent acute episodes in 68, 27 and 5% of the patients, respectively. Recurrent antibiotic therapy was received by 73% of patients with tension-type headache and 66% with migraine. Sinus endoscopy was performed in 26% of the patients. Therapeutic nasal septoplasty was performed in 16% of the patients with a final diagnosis of migraine, and 13% with tension-type headache. Many patients with self-described or primary care physician labeled "sinus headache" have no sinonasal abnormalities. Instead, most of them meet the IHS criteria for migraine or tension-type headache.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Causes of headache in patients with a primary diagnosis of sinus headache

Foroughipour

Sharifian

Shoeibi

et al. 2011

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

show abstract

“…Nasal polyposis that is sufficient to block sinus ostia rarely causes facial pain, unless there is coexisting infection with a purulent discharge [5].…”

Section: Proposed Theories For the Etiology Of Rhinologic Painmentioning

confidence: 99%

“…Chronic sinusitis is, however, usually painless, with episodes of pain occurring during acute exacerbations, which are often precipitated by an upper respiratory tract infection, or when there is obstruction of the sinus ostia by polyps, when pus is present [5]. The pain is often a unilateral, dull ache around the medial canthus of the eye, although more severe facial pain can occur; in maxillary sinusitis, toothache often occurs.…”

Section: Sinogenic Painmentioning

confidence: 99%

“…In cases of facial pain secondary to genuine sinusitis, there are usually endoscopic signs of disease [4]. These patients almost invariably have coexisting symptoms of nasal obstruction, hyposmia, and/or a purulent nasal discharge [5]. In this group with genuine sinusitis, endoscopic sinus surgery has been shown to alleviate facial pain in 75% to 83% of cases [2••,6•].…”

Section: Introductionmentioning

confidence: 99%

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Midfacial segment pain: implications for rhinitis and sinusitis

Jones

2004

Curr Allergy Asthma Rep

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During the past decade, studies on facial pain have shown that there is a distinct group of patients who have a form of facial neuralgia that has all the characteristics of tension-type headache, except that it affects the midface; it is called midfacial segment pain. The pain is described as a feeling of pressure, although some patients might feel that their nose is blocked when they have no nasal airway obstruction. Midfacial segment pain is symmetric, and it might involve areas of the nasion (the root of the nose), under the bridge of the nose, on either side of the nose, the peri- or retro-orbital regions, or across the cheeks. There might be hyperesthesia of the skin and soft tissues over the affected area. Nasal endoscopy and CT scans are typically normal. Most patients with this condition respond to low-dose amitriptyline, but noticeable improvement might require up to 6 weeks.

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Characterization of facial pain associated with chronic rhinosinusitis using validated pain evaluation instruments

DeConde

Mace

Ashby

et al. 2015

Int Forum Allergy Rhinol

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Background Prior investigations into facial pain associated with chronic rhinosinusitis (CRS) have yielded important results, but have yet to utilize pain-specific outcome measures. This study seeks to characterize facial pain associated with CRS using validated pain-specific instruments. Methods Adults with CRS were enrolled into a prospective, cross-sectional study along with control participants presenting with non-CRS diagnoses. Facial pain was characterized in both groups using the Brief Pain Inventory Short Form (BPI-SF) and the Short-Form McGill Pain Questionnaire (SF-MPQ). CRS-specific measures of disease were measured including the Sinonasal Outcome Test-22 (SNOT-22), nasal endoscopy, and computed tomography scoring. Results Patients were comprised of CRS with nasal polyposis (CRSwNP; n=25), CRS without nasal polyposis (CRSsNP; n=30), and control participants (n=8). Subjects with CRSwNP and CRSsNP were less likely to be pain free than controls (16.0%, 6.7% and 62.5% respectively, p=0.001) and carried greater burden of pain as measured by the BPI-SF and SF-MPQ than controls (p=0.002 and p=0.017, respectively). Pain in CRS was most commonly located around the eyes and characterized as ‘throbbing’ and ‘aching’. Nasal polyp status was not associated with differences in character, severity, or location of pain. Conclusions Subjects with CRS have a greater burden of facial pain relative to control subjects across several standardized pain measures. Further, facial pain in CRS significantly correlated to QOL and CRS-specific disease severity measures. Study across larger cohorts using standardized pain measures is warranted to clarify the association of facial pain with chronic rhinosinusitis.

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Nasal polyposis and facial pain

Cited by 50 publications

References 24 publications

Causes of headache in patients with a primary diagnosis of sinus headache

Causes of headache in patients with a primary diagnosis of sinus headache

Midfacial segment pain: implications for rhinitis and sinusitis

Characterization of facial pain associated with chronic rhinosinusitis using validated pain evaluation instruments

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