The Journal of Laryngology & Otology

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

D A Kieffa1a2 and N Y BuSabaa1a2a3 c1

a1 Department of Otolaryngology – Head and Neck Surgery, The Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA

a2 Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA

a3 Division of Otolaryngology, VA Boston HealthCare System, Boston, Massachusetts, USA


Objective: 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.

Results: 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.

Conclusion: 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.

(Accepted January 24 2011)

(Online publication July 27 2011)

Dr N BuSaba takes responsibility for the integrity of the content of the paper

Competing interests: None declared