Clinical Manifestations and Management Challenges in Symptomatic Sinonasal Disorders With Normal CT Scans.

Background: Clinicians frequently encounter patients manifesting with sinonasal symptoms meeting diagnostic criteria for rhinosinusitis, yet demonstrating radiologically-negative sinus computed tomography (CT) findings. These patients typically exhibit poor response to conventional pharmacological therapies. Investigating the pathogenesis of these patients is critically important.

Methods: This retrospective cohort study characterizes 53 cases of CT-negative symptomatic sinonasal disorders (CTN-SSD) compared with 132 chronic rhinosinusitis without nasal polyps (CRSsNP) controls, utilizing standardized metrics including the following: symptom visual analog scale, Lund-Kennedy endoscopic scores, 22-item Sino-Nasal Outcome Test (SNOT-22), and Lund-Mackay CT scoring.

Results: The CTN-SSD group demonstrated a greater proportion of female relative to the control group (73.58% vs 63.36%, P < .001). Of the patients with CTN-SSD in the study, 69.81% fulfilled the International Classification of Headache Disorders, third edition diagnostic criteria for migraine. The CTN-SSD cohort showed significantly-higher prevalence of posterior rhinorrhea (P = .028) and headache/facial pain (P < .001), whereas CRSsNP patients predominantly exhibited nasal obstruction, anterior rhinorrhea, and olfactory dysfunction (P < .001). While mucoid secretion rates were comparable between 2 groups (P = .153), purulent discharge exclusively occurred in CRSsNP cases (P < .001). In addition, mucosal swelling was significantly-more prevalent in CRSsNP patients than in patients with CTN-SSD (P < .001). There was no significant difference in SNOT-22 scores between the 2 groups. However, the CRSsNP group scored higher in the nasal subdomain, whereas the CTN-SSD group demonstrated elevated scores in the aural/facial and psychological subdomains (P < .001).

Conclusions: Patients with symptoms of sinusitis but negative CT finding frequently meet the diagnostic criteria for migraine, and the possibility cannot be excluded that their symptoms are nasal presentations of migraine resembling those of rhinosinusitis, which may result in inappropriate therapies.