- Chronic sinusitis
- Nasal septal deviations
- Sinus cysts or polyps
- Concha bullosa
People often mistake this problem for allergic rhinitis but allergic rhinitis doesn't often include pain. Chronic sinusitis can have many different symptoms, congestion is the most common, but chronic sinus pain may be more specific to sinusitis. Symptoms of chronic sinusitis often flare up and cool down. Antibiotics often help as do steroids (decadron shot, medrol dosepak, or prednisone). People can live with some cases of chronic sinusitis without much interference to their daily life. Flare ups of nasal allergies and viral infections are harder on people with chronic sinusitis. The pain from chronic sinusitis can be over the eyes, between the eyes, over the upper teeth, directed at one or both ears, or in the back of the head. It depends on which sinuses are involved as to where the pain feels like it is.
The bone and cartilage that separates the left and right side of your nasal passage is called the nasal septum. This structure is almost never perfectly straight. When the nasal septum is excessively crooked, it can have sharp spurs of bone that poke into the side wall of the nasal cavity; this is not a rare problem at all. In other cases, a broad area of deviation can touch the side wall. Often there is no history of injury or fracture to explain the deviation. Nasal septal deviations often cause airway obstruction, sometimes on one side, sometimes on both.
Especially when there is a sharp spur of bone, this can cause pain. the pain is usually one sided, it often feels like it is on the side of the face or ear, and it worsens with any causes of nasal congestion. One somewhat helpful diagnostic test that you can do at home is to spray decongestant nasal spray on the side of the pain. If that pain is significantly reduced shortly after spraying, this provides additional evidence of such a abnormality. There is a specific form of para-nasal pain caused by a sharp bone spur called Sluder's Neuralgia.
This type of sinus pain can come and go in severity. The usual first treatment is with steroid nasal sprays and the occasional use of decongestant sprays and oral decongestants. If such treatment is not adequate, you should see a sinus specialist to help confirm the diagnosis and to recommend treatment. A CT scan, X-Ray, or endoscopic exam may be helpful to finalize the diagnosis. Chronic pain from this type of source often benefits from surgical intervention.
Cysts and small polyps within the sinuses are quite common (the most common being a small cyst in the maxillary sinus). In most cases there are no symptoms or problems caused by these benign structures. Sometimes a cyst or polyp obstructs a sinus opening, causing pain secondary to air pressure not equalizing. Usually the cysts are filled with clear or straw colored fluid. Occasionally cysts may contain infected fluid. When they contain infection, they can cause pain that is localize to the area near the cyst itself.
Only with X-Rays or CT scans can one know about sinus cysts and polyps. Even when one is identified, it can be difficult to know if it is a source of pain, in many cases it is not.
This structure is a fairly common normal variant. It is the situation when a normally thin plate of bone, the middle turbinate, develops a bubble or small sinus inside the plate. When this occurs, it causes the middle turbinate to be larger than it is supposed to be. The increase in size permits the middle turbinate to forcefully press on surrounding structures and cause pain. It is sort of like 10 pounds in a 5 pound sack.
Pain from a concha bullosa usually presents between the eyes. The pain can be on one side or both. There is probably a correlation between the size of the concha bullosa and its propensity to cause pain. Many small concha bullosa do not cause any problems.
It takes a CT scan to delineate a concha bullosa and to help give some insight into the likely hood that it is a source of sinus pain. Many smaller concha bullosa are totally without problems. Concha bullosa can be treated with steroid nasal sprays and decongestants, or if the symptoms are difficult to control, a minor surgical procedure.
When no other nasal symptoms are present, it is usually best to pursue other causes first. It is uncommon, but not unheard of, for problems that are truly sinus in origin to cause sinus pain and no other nasal symptoms.
For example, if pain is in the upper teeth, a dentist might be considered first. Pain in the ear can be an ear problem or TMJ syndromes. Pain between the eyes or over the eyes can often be a type of headache, even when it feels like the pain originates in the sinuses. In patients with few other symptoms besides pain, I feel that early CT scanning is helpful, so that other options can be considered if the sinuses don't provide an explanation for the pain.
A quick home test can sometimes help clear things up. If 2 squirts of decongestant spray seem to relieve sinus pain, this would point more towards a sinus origin problem. If the decongestant spray is of no benefit, this does not rule out a primary sinus problem. This is a test, not a treatments. Decongestants sprays can only be used for a few days in a row.
Your sinus pain....
Is it a type of headache?
Can pain be from allergies?
Chronic sinusitis perhaps?
What is a concha bullosa?
Let us help you figure it out.