Mudgil S, Wise S, Hopper KD, Kasales CJ, Mauger D, Fornadley JA. Ann Allergy Asthma and Immunol. 2002;88:223–226
Purpose of the Study.
Sinusitis is typically a clinical diagnosis based on history and symptoms. This study investigated the correlation between clinical symptoms of facial and/or head pain and actual localized findings consistent with a sinusitis on sinus computed tomograhic (CT) imaging.
Two hundred patients with a clinical history of sinusitis that were referred by their internist or otolaryngologist for CT imaging of the paranasal sinuses.
Before the CT scanning, each patient was asked to complete a sinus questionnaire that inquired about pain in 8 different areas of the head and neck, the duration of illness, use of allergy medications, smoking, pets, and seasonal variation of pain symptoms. All CT scans were independently scored by 3 radiologists who were blinded to the patients’ questionnaire responses. The scores were then averaged.
Eighty-two percent reported having some form of facial pain or headache; the right temple/forehead was the most common reported site. Six percent were considered to have acute sinusitis, 14% had a history of sinus surgery, 12% were smokers, and 53% owned pets. Nine percent had no abnormalities on the CT scan. The maxillary sinus was the most frequently (68%) involved sinus. No correlation could be found between the reported sites of pain and findings on CT. Furthermore, no relationships were found between the sinus CT findings and smoking, owning a pet, or duration of pain symptoms. Similar numbers of sites of pain (5.45 and 5.88) were reported between patients with and without CT findings.
This study demonstrated that there was a lack of correlation between reported site of pain and CT findings. Two key points the author stated are 1) symptoms of pain alone may not be sufficient to diagnose sinusitis and 2) the limited value of CT scans for evaluating patients with facial pain/headaches only or patients with a low suspicion for sinusitis.
Most clinical diagnoses of sinusitis involve more than facial pain or headache alone. The diagnosis is based on a compilation of symptoms that may include fever, facial swelling/tenderness, purulent drainage, cough, malodorous breath, and nasal congestion. It is not clear that these patients had more than facial pain alone, which would not be sufficient for clinical diagnosis. Although these patients were referred by internists and otolaryngologists for imaging of their paranasal sinuses, the specific indications for the CT scan are not clear. For example, CT scans may have been ordered after antibiotic treatment to rule out structural abnormalities. Overall, this article does make an important point that facial pain does not equate with sinus disease.