Subjective and objective findings in craniofacial pain and chronic rhinosinusitis

Sirs: The site and severity of headache and facial pain in acute sinusitis is relatively easy to understand, but this relationship in chronic sinusitis can be obscure. In Europe and North America, there are many reports concerning chronic headache and facial pain originating from chronic nasal and paranasal sinus inflammation [1]. In contrast, headache due to rhinitis and sinusitis is reported less frequently in Japanese patients. To determine the clinical characteristics of headache in Japanese patients with chronic rhinitis and sinusitis, we compared results of objective rhinological assessments with the sites and severities of craniofacial pain. One hundred fifty consecutive patients (60 males and 90 females, mean age, 50 years) with chronic rhinitis and/or sinusitis seen in our clinics between April 1990 and March 1991 were investigated in the present study. The severity of headache and facial pain was assessed, and rhinogenic complaints of nasal stuffiness, rhinorrhea, postnasal drip, sneezing and dysosmia were recorded. Rhinoscopic findings with results of sinus X-rays and rhinomanometry (using a Nihon Kohden Rhinorheograph MPR2100) were employed as objective nasal assessments. Total nasal resistances were calculated from the modified equation of Ohm's Law for parallel resistors [3]. Ninety of the patients (36 males and 54 females, mean age, 49 years) had accompanying head and/or facial pain, while 60 patients (24 males and 36 females, mean age, 52 years) had no pain. No significant differences in age and sex between the headache and pain-free groups were found. Although no rhinoscopic findings could be correlated with the severity of pain, symptoms of nasal obstruction and postnasal drip occurred more frequently in those patients with headache. In contrast, the actual location of pain was unrelated to findings on sinus X