Medical Center researchers say headache pain and pressure are not
symptoms of a sinus infection, as traditional medical thought has
In a new study published
in the Head and Neck Surgery Journal, researchers have determined
that extreme fatigue is more likely an indicator of a sinus infection.
The study is already accepted for publication in the Academy of
Dr. James A. Duncavage,
professor of Otolaryngology, directed the study which analyzed sinus
symptoms and their correlation to findings in paranasal CT (computed
"We have good
science and good data here that support the fact that with sinus
pain and pressure symptoms, and the absence of any findings of infection,
either through increased temperature or the patient having some
tenderness over the sinuses, the patients do not have sinusitis,"
will ultimately change the way doctors treat patients. It will take
time, but we need to get the message out to better treat patients."
Assisting in the study
were Dr. Thomas J. Kenny, chief resident in Otolaryngology; Dr.
James P. Bracikowski, assistant professor of Medicine; Dr. Altan
Yildirim, visiting otolaryngology professor from Turkey; Dr. John
J. Murray, M.D., Ph.D., associate professor of Medicine; and Dr.
S. Bobo Tanner, IV, assistant professor of Medicine.
Researchers found that
the severity of five symptoms correlated with the severity of disease
on the CT scan, while headache and facial pain or pressure had no
Duncavage says the
researchers concluded that if patients had symptoms of fatigue,
sleep disturbance, nasal discharge, nasal blockage, or a decreased
sense of smell, they would likely have a sinus infection.
An isolated headache
and facial pain or pressure were less reliable predictors of a sinus
Tradition has been
that the diagnosis of rhino-sinusitis or sinus infection has been
based on the patient's history and a physical exam. Toothaches and
a poor response to decongestants also have been considered predictors
of a sinus infection. This new study changes that.
"This is the first
prospective analysis that demonstrates a correlation between the
severity of CT scan evidence for rhino-sinusitis and the severity
of patient reports of fatigue, sleep disturbance, nasal discharge
or post nasal drip, nasal blockage and decreased sense of smell,"
"I hope our study
shows physicians that they must realize that the severity of selected
sinus symptoms does correlate with the severity of CT imaging evidence
for rhino-sinusitis. The high symptom scores can improve the physician's
confidence in the diagnosis and support treatment without further
Duncavage says he would
treat these patients first with antibiotics. Then, if necessary,
he would do a CT scan.
"The study should
also help physicians realize that in patients with an isolated headache
and/or facial pain or pressure, even if severe, sinus CT scans should
be considered before sinus treatment, early on in their evaluation
phase. It is very likely the headache and pain is caused by some
other problem, not a sinus infection."
Duncavage says that
in chronic sinus disease, the most common symptom he has observed
is that patients have fatigue.
"I have asked
them, 'Do you feel tired?' and some of the patients will actually
break into tears. They will say, 'I have been so tired. There has
got to be something wrong and nobody has been able to figure out
what it is."
"After I have
treated them successfully for their sinus infection, they report
that they have had a major improvement in their energy level."
Duncavage says the
most common diagnosis for patients with a headache and pain or pressure
is a jaw disorder, migraine or vascular headaches or allergy-related
"Many of the patients
who present are fairly desperate and are seeking help, but in order
to be helped they have to have the correct diagnosis. The reason
they continue with the problem is that they haven't had the correct
diagnosis. It usually is not sinusitis.
"The bottom line
is the sicker the patients feel as far as their pain and pressure,
the less likely they are to have sinusitis. The ones that just feel
blah or don't have any energy and don't have any pain over the involved
sinuses, are more likely to have sinusitis."