Symptoms and Clinical Findings in Primary Headache Syndrome Versus Chronic Rhinosinusitis

Abstract

Background Primary headache syndrome (PHS) patients frequently present to otolaryngologists with sinonasal complaints and diagnosis of chronic rhinosinusitis (CRS) due to symptomatic overlap. In this study, we compare demographic, subjective, and objective clinical findings of patients with PHS versus CRS. Methods We retrospectively reviewed a database of patients presenting to a single tertiary care Rhinology clinic from December 2011—July 2017. Sino-Nasal Outcome Test-22 (SNOT) scores and Lund-Kennedy endoscopy scores were obtained. Lund-MacKay CT scores were calculated, if available. Requirement of headache specialist management was compared between PHS and CRS groups. Patients with both CRS and PHS (CRScPHS) that required headache specialist management were compared to patients with CRS without PHS (CRSsPHS) and patients with PHS alone using Kruskal-Wallis analysis of variance. Receiver operating characteristic (ROC) analyses were carried out to determine significant diagnostic thresholds. Results One-hundred four PHS patients and 130 CRS patients were included. PHS patients (72.1%) were more likely than CRS patients to require headache specialist management (6.9%, p<0.0001). CRSsPHS patients had significantly higher Nasal domain scores compared to PHS patients ( p = 0.042) but not compared to CRScPHS patients ( p>0.99). CRScPHS ( p = 0.0003) and PHS ( p<0.0001) subgroups of patients had significantly higher Aural/Facial domain scores compared to CRSsPHS patients. PHS patients also had significantly higher Sleep domains scores compared to CRSsPHS patients ( p<0.0001). Both CRScPHS and CRSsPHS subgroups had significantly higher nasal endoscopy scores ( p<0.0001) and CT scores ( p = 0.04 & p<0.0001, respectively) compared to the PHS group. Aural/Facial domain score of 4, nasal endoscopy score of 4, and CT score of 2 were found to be reliable diagnostic thresholds for absence of CRS. Conclusions The SNOT-22 may be used to distinguish PHS from CRS based upon the Aural/Facial and Sleep domains. Patients with CRS have more severe Nasal domain scores and worse objective endoscopy and CT findings.

Predictors of Non‐Rhinogenic Facial Pain or Pressure in Otolaryngology Clinic

“…Our multivariate model demonstrated that while higher nasal domain scores were associated with sinusitis, higher ear/facial domain scores were associated with NRFP. This is consistent with studies by Wu et al and Sharbel et al, which also reported prominence of ear/facial symptoms in relation to nasal symptoms in patients with NRFP 11,17 . Indeed, our clinical experience has been that patients with NRFP will often complain of ear fullness and vestibular problems in the setting of normal ear exams.…”

“…This is consistent with studies by Wu et al and Sharbel et al, which also reported prominence of ear/facial symptoms in relation to nasal symptoms in patients with NRFP. 11,17 Indeed, our clinical experience has been that patients with NRFP will often complain of ear fullness and vestibular problems in the setting of normal ear exams. With increasing evidence from multiple institutions supporting this, we believe that this can serve as an important clinical differentiator in everyday practice.…”

The predictive utility of the 22‐item sino‐nasal outcome test (SNOT‐22): A scoping review

“…Primary headache disorder patients had significantly higher ear/facial domain and sleep domain scores while CRS patients had a significantly higher rhinologic domain score 22 …”

“…The ear/facial domain can be a significant negative predictor of CRS (Cutoff 4, NPV 0.828, PPV 0.581, Sensitivity 0.894, Specificity 0.442) 22 …”

Olfaction and Beyond: Advancing Our Understanding for Evidence-Based Practice

“…Distinguishing these headache disorders from chronic rhinosinusitis can be challenging and often requires consultation with headache specialists when sinonasal inflammation is not present. In a retrospective study, Sharbel et al 13 sought to compare patients with PHS vs CRSwPHS and CRS alone. They measured SNOT-22 scores and Lund-Kennedy endoscopy scores and Lund-MacKay CT scores (when available).…”