Is ‘sinus’ pain really sinusitis?

Abstract

Chronic pain affecting the mid-face is common in ear, nose and throat clinics, being present in 25% of 7705 patients with nasal complaints (AM Agius, personal data, I 997- 2014). This common symptom typically affects women in their fourth decade and is often associated with headache (Agius, 2010a; Agius et al, 2013a). In patients presenting primarily with facial pain where the presumed diagnosis is chronic rhinosinusitis, up co 60% are subsequently found to have a normal computed tomography scan of the sinuses and normal mucosa on nasal endoscopy (Agius, 2010b) (Figure 1). The European Rhinologic Society in 2012 (Fokkens et al, 2012) reviewed its criteria of facial pain caused by chronic rhinosinusitis by considering computed tomographic and nasal endoscopic evidence. The updated 2013 edition of the International Headache Society confirmed chat nasal pathology should be present ipsilateral to the pain, which should improve together with nasal symptoms on appropriate treatment (Headache Classification Committee of the International Headache Society, 2013).