Sinusitis Disease Process May Determine Degree Of Facial Pain

For the millions of Americans who suffer from chronic rhinosinusitis (CRS), facial pain, characterized as spreading facial pressure, is a frequent symptom. No prior study has established a positive association between facial pain or pressure and CT scan indication of CRS when headache and facial pain/pressure were specifically evaluated. In addition, the specific disease process responsible for the facial pain and pressure has not been previously considered.

The new research study "Association of Radiologic Evidence of Frontal Sinus Disease with the Presence of Frontal Pain," examines the relationship between the presence of frontal pain and CRS disease process, and the association between frontal pain and degree of frontal sinus disease as determined by CT scan. The authors, John M. DelGaudio, MD, and Sarah K. Wise, MD, both from the Department of Otolaryngology-Head and Neck Surgery at The Emory Clinic, and Justin C. Wise, of the Department of Psychology at Georgia State University, all in Atlanta, GA, will present their findings at the Spring Meeting of the American Rhinologic Society being held April 30, 2004, at the JW Marriott Desert Ridge Resort & Spa, Phoenix, AZ.

Methodology: To determine the relationship between frontal pain and radiologic evidence of frontal sinus disease on CT scan, a retrospective chart review was conducted of 207 chronic rhinosinusitis (CRS) patients, diagnosed according to guidelines of the American Academy of Otolaryngology—Head and Neck Task Force on Rhinosinusitis,1997. Patients were treated at The Emory Clinic or Emory University Hospital in Atlanta, GA, between July 1997 and October 2003 with frontal sinus disease or anatomic frontal recess obstruction that was evident on a sinus CT scan. One hundred and nineteen males and 88 females ranging in age from 13 to 84 years (mean of 47.7), were divided into three groups according to disease process: 1) patients with sinonasal polyposis, 2) patients with frontal mucoceles, and 3) patients with non-polypoid (no polyps) CRS unresponsive to medical therapy. Patients were then assigned to groups based on the presence or absence of frontal pain, which was defined as pain, pressure, or headache confined only to the frontal region.

Results: One hundred and ten patients (53 percent) complained of frontal pain, whereas 97 patients stated they were free of frontal pain.

Group 1: 70 (34 percent) had polyps; 20 (29 percent) had frontal pain

Group 2: Thirty-seven (18 percent) of the patients had frontal mucoceles; 31 (84 percent) had frontal pain

Group 3: 100 (48 percent) patients had non-polypoid CRS unresponsive to medical therapy; 59 (59 percent) had frontal pain

A significant difference was found between the distribution of frontal pain among the disease process groups, with the polyp group exhibiting less frontal headache than expected and the mucocele and non-polypoid CRS groups demonstrating more frontal headache than expected.

Patients in groups one and three were further divided into three subsets according to the extent of disease process (as determined by CT scan). A) "opacification," or opaqueness, the presence of minimal air in the frontal sinus; B) "mild-to-moderate thickening," a noticeable circumferential frontal sinus soft tissue thickening of great than 3 mm; and C) "minimal thickening," thickening of less than 3 mm in only the dependent portion of frontal sinus.

Patients with polypoid and non-polypoid CRS who did not exhibit mucoceles were combined and analyzed; 37 percent with complete frontal sinus opacification and 43 percent with minimal mucosal thickening complained of frontal pain. Of patients with mild-to-moderate soft tissue thickening, 64 percent complained of frontal pain. The difference in these groups was significant; the mild-to-moderate thickening group exhibited the highest proportion of frontal pain

Of patients with total or near-total opacification, seven of 38 patients with polyps (18 percent) had frontal pain, whereas 21 of 38 (55 percent) of non-polypoid patients had frontal pain. This difference is statistically significant for patients with opacified frontal sinuses; polyp patients demonstrating less frontal pain and non-polypoid patients exhibiting more frontal pain than expected.

In addition, polyp patients showed increased opaqueness in their frontal sinus. Fifty-four percent of polyp patients exhibited total or near-total opaqueness, while 38 percent of non-polypoid patients had a similar characteristics.One hundred percent of patients that demonstrated air-fluid levels on CT scan complained of frontal pain. No significant difference was found for the distribution of headache between males and females.

Conclusion: A statistically significant difference was found for disease process, as patients with frontal mucoceles and non-polypoid CRS presented with more frontal pain than expected, while patients with polyps presented with less frontal pain. In patients with total or near-total frontal sinus opacification, those with polyps had statistically less frontal pain than expected, while those without polyps had statistically more frontal pain. Non-mucocele patients who exhibited mild-to-moderate mucosal thickening had the highest proportion of frontal pain.

Medical specialists have long declared that sinusitis, chronic and acute, may occur with or without pain. This study offers a link between the sinus disease process and the pain that can be so debilitating.