Does Rhino-genic Headache Improve after Endoscopic Concha Bullosa Surgery in the Adult Patients?

Abstract

Background: Pneumatizaton of Middle Turbinate (MT) is one of the common anatomical variations of the Nasal cavitynamed Concha Bullosa. It may be presented with facial pain or headache. There are several surgical techniques to treatConcha Bullosa.Aim of the study: This is to evaluate the improvement of Rhino-genic headache after endoscopic Concha Bullosa surgeryin adult patients.Patients and methods: A prospective comparative study was designed in the Department of Otolaryngology at Al-Jerahat Teaching Hospital in Medical City and private hospital, Baghdad, Iraq, from March 2019 to August 2020. Fortypatients suffering from headaches of Rhino-genic origin of more than six months duration were enrolled in the currentstudy. Nasal examination by zero-degree endoscope revealed unilateral or bilateral MT enlargement with mucosalcontact points to the Osteo-Meatal Complex or the Nasal Septum. All the patients had Nasal and Para-Nasal sinusesCT scan and xylocaine-xylometazoline test. The Forty patients were allocated into two groups, group A patients treatedby Partial Lateral Middle Turbinectomy (PLMT). The 20 patients in group B had been subjected to Middle TurbinateTransverse Excision (MTTE). Patients followed-up every week in the first month and then every two weeks for the nexttwo months. The headache assessment was achieved preoperatively using the Visual Analogue Scale (VAS) and at thethird postoperative month. Statistical analysis was done using the Chi-square test to compare the VAS scores in group Apatients at the third postoperative month to group B patients, and P-value was calculated.Results: Fifty percent of the patients treated by PLMT became free of headache, 35% had a mild headache, and 15%moderate. In contrast, 85%of the patients subjected to MTTE became headache-free, and 15% still with mild headache (Pvalue= 0.031).Conclusions: MTTE is a better option than PLMT in relieving headaches due to contact between Concha Bullosa andOsteo-Meatal Complex or Nasal Septum.