1. Aleppo Univirsity Hospital Departement of ENT By:Dr.Tarek Shrayyef

2. Introduction: Many ear, nose and throat disorders can cause or contribute to headache. This is because nerves in this region can refer pain into the head and face. Headache is often not a primary symptoms in ENT disorders.

3. primary symptoms. Headache accompanying(secondary) symptoms, advanced stage of diseases. The accompanying symptoms to headache indicate to ENT disorders.

4. Ear disorders can cause headache : Malignant otitis externa. Complications of otitis media.  Mastoiditis.  Petrositis.  Meningitis.  Abscess Subdural. Epidural Brain.  Lateral sinus thrombophlebitis.  Otitic hydrocephalus.

5. Cholesteatoma.  Accuired.  Congenital. Neoplasms:  Acoustic neuroma.

6. Nose disorders can cause headache : Acute sinusitis.  Sinusitis are divided to : Acute rhinosinusitis : less than 4 weeks. Sub acute rhinosinusitis :duration of 4-12 weeks. Chronic rhinosinusitis : more than 12 weeks. Recurent acute rhinosinusitis : greater than four or more episodes of acute rhinosinusitis per year,with each episode lasting more than 7-10 days, with symptom resolution between episodes. Acute exacerbation of CRS : are sudden worsening of CRS with a return to baseline after treatment.

7.  Acute rhinosinusitis devided to : Viral rhinosinusitis : symptoms of acute rhinosinusitis are present less than 10 days + symptoms are not worsening. Acute bacterial rhinosinusitis : symptoms of acute rhinosinusitis are present 10 days or more beyond the onset of upper respiratory symptoms + symptoms of acute rhinosinusitis worsen within 10 days after an initial improvement.  Three cardinal symptoms pulurent rhinorrehea. facial pain / pressure. nasal obstruction

8.  Secondary symptoms that support the diagnosis are : Anosmia. Fever. Aural fullness. Cough. Headache  Over the sinus location (forehead, deep to the eye ).  Pressure, throbbing, dullness, continuous headache.  Headache severity changes over the day (in the morning “maxillary sinus” – at the work “frontal sinus” ).  Increased when head lean forward.

10.  Chronic rhinosinusitis : high fevers are usually absent and headache are often not marked except in acute exacerbations. Obstruction nasal septal deviation. Anterior ethmoidal neuralgia : is due to irritation of the nerve as it enters the roof of the nose,such a situation can occure if the middle turbinate abuts the septum. Paranasal sinus neoplasm. Chronic invasive fungal sinusitis. Complication of sinusitis (acute ethmoidal sinusitis)

11. Acute maxillary sinusitis. The left maxillary sinus is completely opacified and the ostium is occluded.

12. Nasopharynx disorders can cause headache : Adenoid hypertrophy. Nasopharyngeal carcinoma. Juvenile nasopharyngeal angiofibroma.

13. Opopharynx disorders can cause headache : Inflammation. Elongated styloid process : may give rise to symptoms of glossopharyngeal neuralgia by irritating as it pass the tonsil fossa.

14. Neoplasms.

15. Miscellaneous : Temporomandibular disorders. Parapharyngeal space neoplasms.

16. Summary

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