Idiopathic maxillary pain - Prevalence of maxillary sinus hyperreactivity in relation to allergy, chronic mucosal inflammation, and eosinophilia

Objective. In patients with chronic orofacial pain, an underlying sinus hyp erreactivity may contribute to the clinical symptoms of a diagnosis of atyp ical odontalgia, trigeminal neuralgia, or temporomandibular disorders. The purpose of this study was to assess the prevalence of histamine-related max illary sinus hyperreactivity in patients manifesting signs and symptoms of idiopathic maxillary pain and to correlate the respective findings with the presence or absence of chronic maxillary sinusitis-related diagnoses such as allergy, chronic mucosal inflammation, and eosinophilia. Study design. Fifty patients who had been assigned a diagnosis of idiopathi c maxillary pain underwent skin allergy tests, maxillary sinus histamine pr ovocation tests, and maxillary sinus mucosa biopsy. Histamine challenge to a selected area was performed during transoral sinuscopy of the maxillary s inus; a positive test result was defined as the development of a significan t local mucosa response such as reddening and swelling. Results. Comparison of the data showed most patients (38%) to have an absen ce of chronic maxillary sinusitis-related diagnoses, whereas the most commo n multiple diagnosis was found to be chronic mucosal inflammation in combin ation with eosinophilia (22%). Regarding the prevalence rates of positive h istamine provocation test outcomes, a significant difference was found betw een the diagnostic subgroup "absence of chronic maxillary sinusitis-related diagnoses" (36.9%) and the diagnostic subgroups "chronic mucosal inflammat ion" (20%; P <.05), "chronic mucosal inflammation in combination with eosin ophilia" (18.2%; P <.05), and "chronic mucosal inflammation in combination with eosinophilia and allergy" (14.3%; P <.01). An analysis of the distribu tion of chronic maxillary sinusitis-related diagnoses revealed absence of c hronic mucosal inflammation-related diagnoses to be significantly more freq uently associated with positive histamine provocation test outcomes than wi th negative histamine provocation test outcomes (41.2% vs 19.7%; P <.01), w hereas chronic maxillary sinusitis (41.0% vs 29.4%), eosinophilia (26.2% vs 17.6%), and allergy (13.1% vs 11.8%) were found to be more prevalent in pa tients with negative histamine provocation test outcomes. Conclusions. The findings of this study suggest patients with idiopathic ma xillary pain to be associated with a low rate of sinus hyperreactivity, whe reas a positive test outcome with histamine provocation may not be linked t o the presence of chronic maxillary sinusitis-related diagnoses such as all ergy, chronic mucosal inflammation, and eosinophilia. Further investigation s using a larger sample size of patients with idiopathic maxillary pain and nonidiopathic maxillary pain are necessary to demonstrate the presence or absence of an idiopathic maxillary pain-specific prevalence of maxillary si nus hyperreactivity.