Long-term follow-up of patients with facial pain in chronic rhinosinusitis-correlation with nasal endoscopy and CT

Abstract

Aims: Commonly attributed to chronic rhinosinusitis (CRS), facial pain is a frequent presenting complaint in otolaryngology clinics. This study aimed to investigate nasal endoscopy and CT in a cohort of CRS patients presenting primarily with facial pain and to report on their long-term follow-up. Setting: The setting was a busy otolaryngological practice on a small Mediterranean island. A cohort of 305 consecutive patients with chronic rhinosinusitis refractory to maximal medical therapy was assessed clinically, by nasal endoscopy and coronal sinus CT. The primary presenting symptom in 154 of these individuals was facial pain and this paper studied this particular subgroup of CRS patients. Using the Lund-Mckay scoring system, a CT positive for sinusitis was set at 2 or higher. A score of 0 or I was considered negative for sinusitis. The findings in CT positive and CT negative patients were compared. Results: The CT in 61 (40%) patients with facial pain scored positive while 93 (60%) patients had a negative CT. Patients with facial pain as the presenting symptom in rhinosinusitis were significantly less likely to score positive for sinusitis on CT (chi squared test, p<0.0001). CT positive patients were significantly more likely to have pus or nasal polyps (chi squared test, p<0.0001) on nasal endoscopy than CT negative patients. Only 36% of patients with facial pain and other sinusitis symptoms had chronic rhinosinusitis as confirmed by CT and presence of pus or polyps on nasal endoscopy. Patients with positive CT were significantly more likely to be treated surgically while those with a negative CT were significantly more likely to be treated by medication (chi squared test, p<0.0001). Conclusion: Patients were followed up for a mean of two years and their outcomes analysed. The outcome for conservative treatment in CT negative patients (68% good or improved) was not as good as the outcome for surgical treatment in CT positive patients (87% good or improved).