The alteration of craniofacial pain in patients with chronic rhinosinusitis before and after nasal and sinus surgery


cerning chronic headache and facial pain originating from chronic rhinosinusitis, with surgical therapy employed for its relief [1, 4, 9, 10]. In Japan, sinus headache may occur less frequently, but to our knowledge there have been no investigations regarding any changes in pain before or after nasal or sinus surgery. We previously reported the clinical characteristics of chronic craniofacial pain in Japanese patients with rhinosinusitis and compared these with rhinosinusitis patients not having headache and facial pain [6–8]. Accordingly, inconsistent relationships were found between ojective rhinological assessments, which included rhinoscopic findings, sinus X-rays and rhinomanometry, and the site or severity or craniofacial pain. Furthermore, it was suspected that neurotic factors might have a significant role in causing headache and facial pain. We have now assessed changes in crainofacial pain before and after surgical treatment in Japanese patients with chronic rhinosinusitis. In so doing, we used the Cornell medical health questionnaire index (CMI) [2] to assess neurotic tendencies in our patients. Seventy-five patients required surgical treatment for chronic rhinosinusitis between 1993 and 1995. The group contained 54 men and 21 women with a mean age of 49.0 years. Surgery included functional endoscopic sinus surgery (FESS), septoplasty, conchotomy and Caldwell-Luck procedures. The locations and severity of pain were assessed before and after surgery, at which time the CMI was recorded. Additionally, we determined whether patients had nasal allergies by using intradermal testing or radioallergosolvent test (RAST). Nasal resistances at peak flow during quiet nasal breathing were also assessed before and 3–4 weeks after surgery with rhinorheograph MPR-2100 (Nihon Kohden Co.). Total nasal resistances were calculated from the modified equation of Ohm’s law for parallel resisters [5]. The χ2-test and paired or unpaired t-test were used, and statistical significance was accepted as P < 0.05. Twenty-seven of the patients operated on (15 men and 12 women; mean age, 49.3 years) had various degrees of craniofacial pain preoperatively, and the location of this pain was mainly in the frontal and temporal regions. Forty-eight patients (39 men and 9 women; mean age, 48.8 years) had no pain. No significant differences (χ2-test) in age and sex between the headache and pain-free groups were found. Sixteen of the patients with head pain and 19 of the pain-free group had a positive test for allergic rhinitis, but this difference was not significant (χ2-test). Furthermore, no significant differences were found in CMI grading between the two groups. Twenty-three of the 27 patients with head pain noted cure or improvement of pain after surgery, while 3 had no changes in pain and one patient was worse. Nasal resistances after operation in both groups were significantly decreased (paired t-test), but no significant differences (unpaired ttest) in this decrease were found when comparing the group with pain with the pain-free patients (Table 1). The site and severity of headache and facial pain in patients with acute sinusitis are relatively easy to understand, but in chronic sinusitis the relationship can be obscure. Although it is uncommon to reach a diagnosis of chronic sinusitis without abnormal findings on nasal examination, patients who complain to their physicians of frequent sinus headaches may be surprised to learn that their physical findings and histories are not consistent with sinusitis and that sinus X-rays may show no abnormalities [3]. We previously investigated 150 Japanese patients with chronic rhinosinusitis and found that 60% of the patients had headache or facial pain and rhinological assessments, such as rhinoscopic examinations, rhinomanometric results, and sinus X-rays, bore no consistent relationships to the presence, site or severity of craniofacial pain [6–8]. Stammberger and Wolf [11] demonstrated that a combined assessment with CT and rigid endoscopy was invaluable in determining the source of a sinus-related headache. Hoover [4] has reported that sinus headaches could be prevented by control of allergic inflammatory stimuli. However, the results of our present study showed no significant differences in the incidence of allergic rhinitis in our patients without headache. Since our previous studies suggested a role of emotion and mental status in causing sinus headache and facial pain [7, 8], we used the CMI questionnaire to assess neurotic tendencies in our present group of rhinosinusitis patients. Although no significant differences in CMI grading between the headache and pain-free groups were found, individual variability could not be excluded. It is well known that so-called idiopathic headache in certain patients can be cured by the correction of nasal abnormalities, such as compression between the nasal septum and the middle K. Naito · S. Miyata · S. Iwata

DOI: 10.1007/s004050050016

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@article{Naito1998TheAO, title={The alteration of craniofacial pain in patients with chronic rhinosinusitis before and after nasal and sinus surgery}, author={Kensei Naito and Satoshi Miyata and Sachiko Iwata}, journal={European Archives of Oto-Rhino-Laryngology}, year={1998}, volume={255}, pages={22-23} }