Therapeutic Effects of Endoscopic Sinus Surgery in Eosinophilic Sinusitis Patients with Severe Headache

Abstract

Background: Eosinophilic Chronic Rhinosinusitis (ECRS) is an intractable disease with symptoms that affect daily life, such as nasal obstruction and olfactory disturbances. Among the symptoms, headache is the symptom that most affects daily life. Method:In this study, we examined and compared the clinical findings of 40 ECRS patients who underwent Endoscopic Sinus Surgery (ESS) at our hospital, focusing on eight patients who complained of severe headache. The 40 ECRS patients were divided into three groups: those with severe headache (group S) (n=8), moderate headache (group M) (n=14), and without headache (group N) (n=18), and the clinical features in each group were compared. The six main symptoms of the three groups were compared using the Nasal Symptoms Questionnaire (NSQ) before and 2 years after surgery.Results: In group S, there was a significant improvement in headache after ESS in all patients (P<0.05). In the S+M group, 91% of patients showed improvement in headache after ESS. In each of the three groups, most of the symptoms, and not only headache, were significantly improved after ESS. In group S, six patients (75%) expressed preoperative improvement in headache symptoms with oral steroids. This suggests that it might be possible to preoperatively determine whether headache is caused by ECRS or other causes based on whether it improves with preoperative steroid therapy. Intergroup comparisons showed that more patients in group S had a short anteroposterior diameter of the frontal sinus than in the other groups, and evaluation indicated that ECRS patients with a short antero-posterior diameter of the frontal sinus are more likely to have severe headache. Conclusion:ESS led to a significant improvement in all symptoms in ECRS cases. Severe headache is known to interfere with daily life in ECRS patients. We speculated that patients with severe headaches might show a relatively greater improvement in headache severity after ESS. However, since ECRS is a recurrent disease, postoperative follow-up and treatment, such as with nasal rinses and steroid nasal sprays, are very important for maintaining the efficacy of surgery.