Sinusitis - facial pain

What is sinusitis?

In sinusitis patient can experience a blocked nose, nasal discharge, congestion, facial pain, reduced sense of smell and catarrh.  The symptoms usually clear up within two weeks, but the sensation of catarrh can last much longer. The problem can return or even persist. It occurs in any age group and is equally distributed between males and females.

What causes sinusitis?

Sinusitis usually occurs with a head cold (also known as acute rhinitis). Head colds are caused by viruses being inhaled into the skin of the nose. The viruses are transported from other infected patients by small droplets eg after a sneeze. The virus infects the skin of the nose and causes swelling, discharge and even occasional bleeding. The swelling blocks the natural openings to the sinuses and causes the mucus to collect in them. The virus also weakens the skin's defence to the body's "friendly bacteria". These grow in the mucus causing it to change from white to yellow or even green. The symptom of facial pain is very variable. Some patients have no pain at all and some are very troubled by it. The degree of facial pain seems to be related to the sensitivity of the nerves to the face. People who have previously had migraines or neuralgia tend to have more pain than others.

What can I do?

After a few days the body makes antibodies to kill the virus and the swollen skin of the nose usually settles down. This allows the mucus to come out of the sinuses and all the symptoms gradually subside. The symptom of catarrh is usually the last one to improve.

It is reasonable to use a decongestant such as Vick's Sinex or Otrivine in the first few days to improve nasal breathing. There are also decongestant tablets. Pain killers should be taken as required. Antibiotics are usually only given once the mucus turns green. Green mucus signifies a bacterial growth. Antibiotics do not work against viruses.

Patients who have repeated attacks of sinusitis should be assessed by an ENT surgeon to identify any abnormalities which may be causing the repeat attacks. These include structural abnormalities, such as a deviated nasal septum or nasal polyps. Other factors are hay fever (allergic rhinitis) and migraines.

What can the specialist offer?

The ENT specialist will take a careful history and examine your nose. This may include examining it with an endoscope, which is a painless way of looking at the opening to the sinuses. You may be given a skin test to check for allergies. A scan of the sinuses is useful sometimes.

Depending on the results of the tests, the specialist will explain the diagnosis and discuss the treatment options. These may include medication for allergies or migraine and surgery for structural abnormality. Surgery to improve the nasal airway includes septoplasty, septorhinoplasty and sub mucous diathermy of the turbinates. Surgery to unblock the sinuses includes endoscopic sinus surgery and polypectomy.