Utility of Existing Patient-Reported Outcome Measures for Identifying Non-Rhinogenic Facial Pain

Facial pain/pressure is often non-rhinogenic and migraine-related in etiology. However, this is frequently misdiagnosed as sinusitis, leading to inappropriate antibiotic utilization and unnecessary procedures. We assessed the utility of the 3-Item Identify Migraine (ID Migraine) and the 22-Item Sinonasal Outcomes Test (SNOT-22) in differentiating rhinogenic vs. non-rhinogenic facial pain/pressure (NRFP).

Patients presenting to the rhinology clinic with a complaint of facial pain/pressure completed the ID Migraine and SNOT-22. A diagnosis of CRS or NRFP was given based on imaging criteria. Receiver Operating Characteristics (ROC) were determined to evaluate the ability of the PROMs to identify NRFP.

Of the 251 patients enrolled, 114 had CRS and 137 had NRFP. Mean (SD) age was 50 (16), and 69.3% (n = 174) were women. The ID Migraine had a positive predictive value of 0.66 (95% CI: 0.57 to 0.74) and a negative predictive value of 0.57 (95% CI: 0.48 to 0.66), with an AUC of 0.64 (95% CI: 0.58 to 0.71). The SNOT-22 had an AUC of 0.64 (95% CI: 0.58 to 0.71) using the combined five domain scores, with the function domain score having the highest AUC at 0.60 (95% CI: 0.53 to 0.67).

Existing PROMs have limitations when used to identify NRFP in patients presenting with facial pain/pressure. A screening questionnaire developed and validated specifically for this purpose would assist clinicians in early diagnosis and appropriate management of these patients. Given the high incidence of NRFP, this measure could significantly improve healthcare efficiency.