The prevalence of facial pain and purulent sinusitis

Misconceptions about the causation of facial pain have led to wrong conclusions about the prevalence of chronic rhinosinusitis.

Recent work challenges the belief that most facial pain is caused by sinusitis and that chronic purulent sinusitis causes pain; this review qualifies these statements in the light of current evidence.

The majority of patients with facial pain have a neurological cause and, of these, the most common is midfacial segment pain, which is a version of tension-type headache that affects the midface. Although acute infective sinusitis often causes pain, chronic infective sinusitis (who make up a small proportion of patients with chronic rhinosinusitis) usually causes pain only when there is an acute exacerbation. There is an increasing body of evidence that psychological or neurochemical factors may play a part in many patients' facial pain as associations between facial pain, unexplained chronic fatigue, irritable bowel, multiple symptoms and a maternal history of chronic pain have recently been described.