Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia.
Medical College of Georgia, Augusta University, Augusta, Georgia.
Am J Rhinol Allergy. 2021 May;35(3):308-314. doi: 10.1177/1945892420956530. Epub 2020 Sep 3.
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.
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.
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%, <0.0001). CRSsPHS patients had significantly higher Nasal domain scores compared to PHS patients ( = 0.042) but not compared to CRScPHS patients (>0.99). CRScPHS ( = 0.0003) and PHS (<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 (<0.0001). Both CRScPHS and CRSsPHS subgroups had significantly higher nasal endoscopy scores (<0.0001) and CT scores ( = 0.04 & <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.
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.
原发性头痛综合征（PHS）患者常因症状重叠而向耳鼻喉科医生就诊，并被诊断为慢性鼻-鼻窦炎（CRS）。在本研究中，我们比较了 PHS 与 CRS 患者的人口统计学、主观和客观临床发现。
我们回顾性分析了 2011 年 12 月至 2017 年 7 月在一家三级耳鼻喉科诊所就诊的患者数据库。获得了鼻-鼻窦炎结局测试 22 项（SNOT-22）评分和 Lund-Kennedy 鼻内镜评分。如果有，则计算 Lund-Mackay CT 评分。比较 PHS 与 CRS 组之间对头痛专家管理的需求。比较需要头痛专家管理的 CRS 伴 PHS（CRScPHS）患者与无 PHS 的 CRS（CRSsPHS）患者和单纯 PHS 患者，采用 Kruskal-Wallis 方差分析。进行了受试者工作特征（ROC）分析，以确定显著的诊断阈值。
纳入了 104 例 PHS 患者和 130 例 CRS 患者。PHS 患者（72.1%）比 CRS 患者更需要头痛专家管理（6.9%，<0.0001）。与 PHS 患者相比，CRSsPHS 患者的鼻腔域评分显著更高（=0.042），但与 CRScPHS 患者相比无显著差异（>0.99）。与 CRSsPHS 患者相比，CRScPHS（=0.0003）和 PHS（<0.0001）亚组患者的耳部/面部域评分显著更高。PHS 患者的睡眠域评分也显著高于 CRSsPHS 患者（<0.0001）。CRScPHS 和 CRSsPHS 亚组的鼻腔内镜评分（<0.0001）和 CT 评分（=0.04 和<0.0001）均显著高于 PHS 组。发现耳部/面部域评分 4 分、鼻腔内镜评分 4 分和 CT 评分 2 分是 CRS 不存在的可靠诊断阈值。
SNOT-22 可根据耳部/面部和睡眠域将 PHS 与 CRS 区分开来。CRS 患者的鼻腔域评分更严重，且客观鼻内镜和 CT 检查结果更差。
