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Patients with Head or Facial Pain Should Get CT Scan Before Sinusitis Treatment

Most patients with complaints of facial pressure/pain and headache receive treatment for sinusitis from their primary care physician or referral to an otolaryngologist--head and neck surgeon (ear, nose, and throat specialist). This may be a premature course of treatment according to six medical specialists in Tennessee.

In September of 1999, the medical specialists completed the first prospective study showing a correlation between the severity of sinus symptoms and CT scan of sinusitis.

Their research, "Prospective Analysis of Sinus Symptoms and Correlation with Paranasal Computer Tomography (CT) Scan" provides the first link between a patient's actual sinus symptoms and the corresponding display of symptoms on a CT scan, a relationship not previously confirmed in existing medical literature. Consequently, the research concludes that when only facial pain and headaches are present, a CT scan may eliminate sinusitis as the cause of the patient's discomfort.

The study was conducted under the auspices of the Vanderbilt Sinus, Asthma, and Allergy Program (ASAP) at the Vanderbilt Bill Wilkerson Center for Otolaryngology and Communications Services, Vanderbilt University Medical Center, Nashville, TN. Participating in the research were Thomas J. Kenny, MD, James Bracikowski, MD, James Duncavage, MD, John J. Murray, MD, S. Bobo Tanner, MD, and Altan Yildirim, MD, all from Nashville.

Study Methodology:
304 patients with a referred diagnosis of sinusitis seen at the Vanderbilt ASAP between March and September of 1998 were prospectively analyzed to detect whether or not the severity of their symptoms correlated with CT scan evidence of sinusitis. Patients included in the study had a scan the same day of their visit and completed two questionnaires, the Rhinosinusitis Outcome Measure and the Rhino- conjunctivitis Quality of Life Questionnaire. Seven symptoms of sinusitis were assessed.

Research Results:
Of the 304 subjects, 171 (56 percent) were female, 133 (46 percent), male. The average age of patients was 43.7 years with a range of 8 to 82 years old. Of the seven symptoms analyzed, the severity of five (fatigue, lack of good night's sleep, nasal discharge, stuffy nose, and decrease sense of smell) were found to correlate with the CT display of symptoms. The severity of two symptoms, headache and facial pain, had no correlation with the results found on the radiographic image.

The researchers ranked the sum of all seven symptoms from each patient and compared them to the rank of individual CT scores. After deleting scores for headache and facial pain, a highly significant relationship between symptoms and the CT scan was found.

Effective pain management is essential to improving the quality of life of any patient. This study offers the medical community a course of action to determine if facial pain and headaches are caused by disorders other than sinusitis.
Source: American Academy of Otolaryngology Head and Neck Surgery (AAOHNS)


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