Audit of CT scanning of paranasal sinuses in patients referred with facial pain

Abstract

Background: Computed tomography (CT) scans are performed by some clinicians in the belief that they are a useful primary investigation in patients with facial pain. Objective: To assess the appropriateness and outcome of sinuses CT scans in patients with facial pain based on the European Position Paper on Chronic Rhinosinusitis and Nasal Polyps (EPOS) 2007 guideline and International Headache Society (IHS) criteria for diagnosing and investigating rhinosinusitis. Methodology: The first cycle of audit was performed on 50 patients with facial pain who underwent CT scanning. The findings on nasal endoscopy, Lund-Mackay scores (LMS) of the scans and management of these patients were analysed. Following implementation of the IHS and EPOS criteria, 50 consecutive patients were re-audited. Results: In the first cycle, 16% of patients had positive nasal endoscopic findings. Thirty patients had LMS of 0 and only 9 showed significant changes (LMS ≥ 8) on their scans. In the second cycle, only 10 patients underwent CT imaging as per EPOS guideline and 4 of them showed significant changes. The remaining 80% of patients in this cycle were diagnosed and treated for non-sino- genic causes. Conclusion: Applying the IHS and EPOS criteria has reduced the number of inappropriate CT scans requests and allowed consideration of non-sinogenic aetiologies.