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Utility of Existing Patient-Reported Outcome Measures for Identifying Non-Rhinogenic Facial Pain
David W Jang1, Hui-Jie Lee2, Ralph Abi Hachem1
1Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina, USA.
The Laryngoscope
|March 22, 2025
Summary
Facial pain is often migraine-related, not sinusitis. Current tools like the 3-Item Identify Migraine (ID Migraine) and 22-Item Sinonasal Outcomes Test (SNOT-22) have limitations in differentiating causes of facial pain.
Area of Science:
- Otolaryngology
- Neurology
- Diagnostic Accuracy
Background:
- Facial pain/pressure is frequently misdiagnosed as sinusitis, despite often being non-rhinogenic and migraine-related.
- This misdiagnosis can lead to inappropriate antibiotic use and unnecessary procedures.
Purpose of the Study:
- To assess the utility of the 3-Item Identify Migraine (ID Migraine) and the 22-Item Sinonasal Outcomes Test (SNOT-22) in differentiating rhinogenic facial pain from non-rhinogenic facial pain/pressure (NRFP).
Main Methods:
- Patients presenting with facial pain/pressure completed the ID Migraine and SNOT-22 questionnaires.
- Diagnosis of chronic rhinosinusitis (CRS) or NRFP was based on imaging criteria.
- Receiver Operating Characteristics (ROC) analysis was used to evaluate the PROMs' ability to identify NRFP.
Main Results:
- The study included 251 patients (114 with CRS, 137 with NRFP).
- The ID Migraine showed an Area Under the Curve (AUC) of 0.64.
- The SNOT-22 also had an AUC of 0.64, with its function domain scoring 0.60.
Conclusions:
- Existing patient-reported outcome measures (PROMs) have limitations in identifying NRFP in patients with facial pain/pressure.
- A dedicated screening questionnaire is needed to aid clinicians in early diagnosis and appropriate management.
- Developing such a tool could improve healthcare efficiency given the high incidence of NRFP.
