Abstract
Dear Sir First, we would like to emphasize that surgical management is beneficial only in ‘selected’ patients, not necessarily for all sinus headache patients. Due to a lack of good diagnostic criteria for sinus headaches, confusion exists. If using the Stammberger and Wolf classification system, our patients belong to the first group, which is headache specifically linked to abnormalities in the paranasal sinuses, such as inflammatory disease, neoplasm, barotraumas, or other readily identifiable causes (please see the diagnostic criteria section of the Discussion, p. 425, for details).
Our paper identified 1500 patients who had nasal surgery with headache as one of the chief complaints. They all had sinus pathologies. However, headache was not the major concern of these patients, and most of them were bothered by rhinological symptoms such as purulent rhinorrhoea, nasal obstrucion (in acute or chronic rhinosinusitis patients), neoplasm (sinus carcinoma), or orbital/intracranial complications of rhinosinusitis. There were a variety of surgeries, which were selected according to the patients' underlying conditions. Therefore, they were excluded from the study. In addition, we excluded contact point headache to avoid confusion (as mentioned in the exclusion criteria of the Materials and methods section). What we cared about were only the patients who really had paranasal sinus pathologies in patients presenting with headache as a primary symptom. This is why the study group is so small (36/15 000). As a result, the conclusion indicates that surgical management can be beneficial in such a limited group of sinus headache patients.
Our opinion about the role of imaging is exactly the same as that of Daudia and Jones (clinical approach section of the Discussion, symptoms p. 426).
Our study tries to clarify what Daudia and Jones write in their letter: ‘In the experience of the senior author, chronic sinusitis, fungal sinusitis and mucolcoeles are usually painless’. There did exist a small group of patients with these diseases that had headache as their primary symptom, and surgical management could be of benefit in the treatment of such sinus headache patients.
Because we found that confusion exists, our conclusions recommend that a new definition of sinus headache and criteria for diagnosis should be created, instead of just stating that chronic sinusitis is not valid as a cause of headache or facial pain.
We are in complete agreement with the conclusion, ‘we would exercise caution against recommending sinus surgery for patients with headache or facial pain, particularly as a primary symptom’. However, this is not what we were trying to express in our paper.
We thank Daudia and Jones for their valuable opinions.