ABSTRACT
Patients with facial discomfort often make a self-diagnosis of ‘‘rhinitis’’ or ‘‘sinusitis’’ as they know that their sinuses lie within the face. In the medical literature, rhinological causes of facial discomfort include acute infective rhinosinusitis that is typically preceded by an upper respiratory tract infection and responds to antibiotics unless it does not resolve of its own accord. In the past, chronic infective rhinosinusitis has been reported as a common cause of facial pain, but with the advent of nasal endoscopy and computed tomography (CT), this conclusion has been questioned (1). A significant proportion of patients with symptoms of facial discomfort, pressure, heaviness, or blockage and having been treated by endoscopic sinus surgery (ESS) are found to have persistent symptoms after surgery (2-4). It is notable that over 80% of patients with purulent secretions visible at nasal endoscopy have no facial discomfort or pain (3). If patients who have intermittent symptoms of facial discomfort, pressure, heaviness, or blockage believe that it is due to infection, yet when they are seen they have no pain or objective signs of infection, they are asked to return when they are symptomatic. When they do return with symptoms of facial discomfort, many are found not to have any evidence of infection, and another neurological cause for their pain is often responsible (3). In cases of facial discomfort secondary to genuine sinusitis, there are usually endoscopic signs of disease (5), and these patients almost invariably have coexisting symptoms of nasal obstruction, hyposmia, and/or a purulent nasal discharge (6). In patients with genuine sinusitis, ESS has been shown to alleviate their facial discomfort in 75% to 83% of cases (3,7). Other causes of facial discomfort or pain include atypical forms of migraine (8), cluster headache, and paroxysmal hemicrania (9), and atypical facial pain may be responsible among the causes in the differential diagnosis (10).
