By Professor Ram Dhillon, Consultant ENT Surgeon at The Princess Grace Hospital, part of HCA Healthcare UK.
Sinuses are small, air-filled cavities inside your forehead, cheekbones, and behind the bridge of your nose. They primarily exist to produce a mucus that moisturises the inside of the nose and protects from pollutants, dust and dirt. However, when they get inflamed, they can swell, create more mucus, and the channels that drain them can get blocked.
The common symptoms of sinus infection include swelling and pressure around your cheeks, eyes, forehead or over your teeth; headache; copious nasal discharge, a high temperature; blocked nose; a reduced sense of smell and bad breath. An active sinus infection may require antibiotics and, in some cases, even hospital admission.
However, having facial or sinus pain doesn’t always mean you have sinusitis. In fact, in the majority of cases this pain is due to allergic rhinosinusitis, which has many of the hallmarks of a sinus infection.
What is allergic rhinosinusitis?
There is rarely a cure for underlying allergies and so to assist those with allergic rhinosinusitis, the doctor will take a patient history, perform an examination of the nose with a special telescope (which is painless) and carry out blood tests to identify the subtances (allergens) which are causing the sensitivity in the nose.
These are likely to reveal multiple sensitivities, with grasses, pollen, dust and pet dander among the most common. Many individuals will also have a family history of atopy (allergy) disorder, such as hay fever, asthma, eczema or drug allergies.
Fortunately, there are numerous treatment options available as well as temporary ways to relieve sinus pressure at home including:
A humifidier will keep your environment moist, which in turn can help your sinuses to open and alleviate the pressure. Inhaling the steam from a pan of hot (not boiling) water can also help to reduce swelling.
Try placing a warm compress across your forehead, eyes, and over the nose to relieve sinus pressure at home.
Nasal sprays or drops
Nasal sprays or drops can also bring an improvement in symptoms and minimise the sensitivity reaction as they help to wash away the germs and allergens that are causing the swelling.
OTC pain relief
A range of over the counter pain relief options help to keep sinus pain at bay, particularly ibuprofen and naproxen. However, you should always ensure you follow the dosing instructions carefully and check they won’t react with any other medication you may be taking.
Antihistamine tablets may also be useful, however, these have the potential drawback of producing drowsiness.
Occasionally, if you have a single identified allergen, you may be suitable for a series of desensitisation injections, which are performed under strict conditions due to their potential side effects.
While the majority of symptoms improve with the medical treatment described, a small percentage of patients may be offered surgery if the nasal lining is swollen and blocking the ventilation of the sinuses. Sometimes, benign allergic nasal polyps may need to be removed, as they can block the nose and sinuses, leading to facial discomfort and sometimes pain.
Are there any other causes of facial or sinus pain?
Another cause of sinus pain is related to abnormalities of the jaw joint, which results in a dysfunctional joint. This often presents with pain and crackling in the ear, which are associated with sinus or nose problems. However, the pain is also located in the cheek, hence the confusion with sinusitis by many patients!
This is easily diagnosed when an ear disorder is excluded by an ENT (Ear, Throat and Nose) specialist. The joint dysfunction can then be managed, invariably with medication and occassionally by fitting a dental appliance.
Recurrent migraine headaches, which are classically one sided and localised to the forehead, are also frequently mistaken for sinusitis. These patients may end up having several courses of antibiotics, without relief of symptoms, before getting referred to an ENT specialist. Again, a good history and clinical examination makes the diagnosis and appropriate medication can be prescribed to prevent migraine related facial pain.
More rarely, facial pain of a neuralgic nature may be confused with sinusitis. Neuralgic pain is sharp and stabbing and usually has a trigger, such as shaving, touching the face or putting on makeup. This requires a specialist referral with investigations such as X rays, before deciding on management.
When to see a doctor
For the vast majority of people, sinus pain is usually not sinusitis but allergy and can be managed very effectively. However, if your symptoms persist, you should schedule an appointment with your GP or an ENT specialist who can help to determine the cause of your symptoms.
About the expert
Professor Ram Dhillon is a Consultant ENT Surgeon at The Princess Grace Hospital, part of HCA Healthcare UK.
The Princess Grace Hospital is recognised as one of the UK’s best-equipped, multidisciplinary, acute private hospitals, offering access to the latest innovative technology and pioneering medical treatment for Breast Care, Oncology, Orthopaedics, Gastroenterology, Urology and Sports Medicine. Find out more at www.theprincessgracehospital.com