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Negative predictive value of normal nasal endoscopy for sinus disease as a cause of isolated facial pain

  • D A Kieff (a1) (a2) and N Y BuSaba (a1) (a2) (a3)

To determine the negative predictive value of normal nasal endoscopy in assessing paranasal sinus disease as the cause of isolated facial pain in the sinus regions.

Subjects and methods:

The study group comprised 42 consecutive adult patients presenting with the isolated symptom of facial pain, and a negative nasal endoscopy. Patients underwent sinus computed tomography to determine whether radiographic findings indicated a sinugenic aetiology.


Patients comprised 27 women and 15 men, with a median age of 38 years. Twenty patients had unilateral pain, 33 per cent had sinus radiographic findings that might explain their facial pain, and 10 per cent had imaging demonstrating mucosal disease in one or more sinuses correlating with the location of the facial pain. Thirty-one per cent had anatomical radiographic findings that could potentially obstruct the osteomeatal unit.


Normal nasal endoscopy had a negative predictive value of 67 per cent in excluding a sinugenic cause of isolated facial pain, if radiographically determined anatomical factors and mucosal disease were both included as positive findings; this rose to more than 90 per cent if only those patients with mucosal sinus disease were considered as true positive patients.

Corresponding author
Address for correspondence: Dr Nicolas BuSaba, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston MA 02114, USA Fax: +1 617 573 3914 E-mail:
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1 ME Mehle , CP Screiber . Sinus headache, migraine, and the otolaryngologist. Otolaryngol Head Neck Surg 2005;133:489–96

2 RK Cady , CP Schreiber . Sinus headache: a clinical conundrum. Otolaryngol Clin North Am 2004;37:267–88

4 SJ Zinreich , DE Mattox , DW Kennedy , ME Johns , JC Price , MJ Holliday Concha bullosa: CT evaluation. J Comput Assist Tomogr 1988;12:778–84

6 GN McAbee , GE Siegel , S Kadakia , E Cantos . Value of MRI in pediatric migraine. Headache 1993;33:143–4

8 B Wallwork , W Corman , A MacKay-Sim , L Greiff , A Cervin . A double-blind, randomized, placebo-controlled trial of macrolide in the treatment of chronic rhinosinusitis. Laryngoscope 2006;116:189–93

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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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