Surgical management of headache and facial pain/pressure in chronic rhinosinusitis: A systematic review and meta-analysis.

ABSTRACT

BACKGROUND: Headache and facial pain are common symptoms of chronic rhinosinusitis (CRS). However, given the numerous etiologies that can cause these symptoms, the impact of sinus surgery is not well characterized. METHODS: A systematic review was performed by searching the literature from inception through June 6, 2023. English-language articles reporting outcomes for facial pain/pressure or headache following endoscopic sinus surgery were selected for inclusion. Meta-analyses were performed using random and fixed effect models on continuous measures (mean), mean difference (Δ), and proportions (%). RESULTS: A total of 26 articles reporting on 2839 patients were selected for inclusion. The mean patient age was 44.0 ± 3.9 (range 16.0-84.0), with an average symptom duration of 5.3 ± 2.8 years. Among these patients, 56.5% (95% confidence interval [CI] 52.3-60.6) were male and 77.0% (95% CI 56.6-92.3) had nasal polyposis (NP). Patients with and without NP reported substantial reductions in both 22-item sino-nasal outcome test facial pain/pressure (with NP -1.4 [95% CI -1.6 to -1.2; relative reduction 59.1%]; without NP -1.5 [95% CI -1.9 to -1.1; relative reduction 60.9%]) and visual analogue scale (VAS) headache (with NP -2.5 [95% CI -2.8 to -2.1; relative reduction 67.2%]; without NP -2.8 [95% CI -4.7 to -1.0; relative reduction 42.7%]). Symptom reductions were greater in the without NP versus with NP group; VAS facial pain/pressure Δ0.4 (95% CI 0.2-0.6; p = 0.0006) and VAS headache Δ0.4 (95% CI 0.1-0.7; p = 0.02). CONCLUSIONS: Our findings suggest that CRS patients, regardless of polyp status, benefit from significant reductions in facial pain/pressure and headache following surgical therapy.