Journal article
Neurologic diagnosis and treatment in patients with computed tomography and nasal endoscopy negative facial pain
The Laryngoscope, Vol.114(11), pp.1992-1996
11/2004
DOI: 10.1097/01.mlg.0000147935.59755.45
PMID: 15510029
Abstract
To determine the helpfulness of specialist neurology referral for patients with facial pain, a normal sinus computed tomography (CT) scan, and normal nasal endoscopy findings.
Prospective identification of patients and analysis of data approved by the Institutional Review Board.
The data of 104 consecutive patients presenting with facial pain, a normal sinus CT scan, and normal nasal endoscopy findings were reviewed. The patients presented to a single rhinologist in a tertiary care institution. All patients were referred for specialist neurologic evaluation and potential treatment. Further information was obtained from a patient survey.
Of the 104 patients, 81 were women and 23 were men. The average age was 46 years (range, 22-85). Fifty-six had clear CT scans, 48 had minimal change, and all had negative endoscopies. Twenty-nine had previous unsuccessful sinus surgery. The average follow-up period was 10.5 months. Forty of 75 patients seeing a neurologist were seen on multiple occasions. Four percent of patients seen by a neurologist had an unsuspected serious intracranial diagnosis. The most common diagnoses were migraine (37%), rebound headache (17%), chronic daily headache (17%), and obstructive sleep apnea (16%). Overall, 58% improved on medical therapy; 60% of those with a clear CT scan improved, and 53% of those with minimal change on CT scan improved (P = .749).
Facial pain remains a difficult symptom to diagnose and treat in rhinologic practice. Patients often undergo surgery without help. Most patients with facial pain, a normal sinus CT scan, and normal endoscopy findings benefit from neurologic consultation. Serious intracranial pathologic conditions can be excluded and diagnosis-specific pharmacogenetic therapy instituted with improvement in more than 50%.
Details
- Title: Subtitle
- Neurologic diagnosis and treatment in patients with computed tomography and nasal endoscopy negative facial pain
- Creators
- Eric P Paulson - Department of Otolaryngology--Head and Neck Surgery, University of Iowa, Iowa City, Iowa 52242-1093, USAScott M Graham
- Resource Type
- Journal article
- Publication Details
- The Laryngoscope, Vol.114(11), pp.1992-1996
- Publisher
- United States
- DOI
- 10.1097/01.mlg.0000147935.59755.45
- PMID
- 15510029
- ISSN
- 0023-852X
- eISSN
- 1531-4995
- Language
- English
- Date published
- 11/2004
- Academic Unit
- Neurosurgery; Otolaryngology
- Record Identifier
- 9984006415802771
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