Comprehensive management of patients presenting to the otolaryngologist for sinus pressure, pain, or headache

Devyani Lal, Alexis Rounds, David W. Dodick

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Objectives/Hypothesis: To study differential diagnosis and efficacy of management strategies in patients presenting to an otolaryngologist for sinus pressure, pain, or headache. Study Design: Retrospective analysis at an academic medical center. Methods: Patients were seen in the clinic (2010-2012) for sinus-related headache, pressure, pain or fullness (study symptoms) by a rhinologist. A retrospective chart review of patients with study symptoms was conducted. Results: Of 211 patients with study symptoms, 70.62% met American Academy of Otolaryngology-Head and Neck Surgery criteria for sinusitis or had rhinologic disease. Otolaryngic therapy alone (medical or surgical) relieved study symptoms in 51.66%; combined neurology intervention helped another 15.17%. Nearly half of the patients (48.82%) were diagnosed with primary headache disorders. Comorbid rhinologic-neurologic disease was present in 27.96% and odontogenic disease in 7%. Initial otolaryngology referral was likely unnecessary for 36.49% of the study patients. Sinus computed tomography (CT) was available for 91% of 211 patients, and 80% of scans were positive. Endoscopic sinus surgery (ESS) was used in only 80/ 211 patients (37.69%) and was effective in 66/211 (31.28%). ESS was most successful in patients receiving concurrent neurological intervention. The Lund-Mackay CT score did not predict outcomes from ESS. Interdisciplinary otolaryngology-neurology efforts resulted in a positive outcome for 92.4% of patients. Conclusions: We present the first series detailing management of patients with sinus-headache pain in an otolaryngology practice. Such symptoms have multifactorial etiologies. Positive sinus CT results require cautious interpretation. ESS should be judiciously used. Interdisciplinary care is critical for success: approximately 50% of patients benefited from otolaryngic management, 50% needed neurological treatment, and 7% required dental disease management.

Original languageEnglish (US)
Pages (from-to)303-310
Number of pages8
Issue number2
StatePublished - Feb 1 2015


  • Chronic rhinosinusitis
  • Facial fullness
  • Facial pain
  • Facial pressure
  • Headache
  • Migraine
  • Primary headache disorder
  • Sinus disease
  • Sinus headache
  • Sinus pain
  • Sinus pressure
  • Sinusitis
  • Tension headache

ASJC Scopus subject areas

  • Otorhinolaryngology


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