Facial pain is linked with high levels of healthcare utilization and significant morbidity and continues to be a challenge in both diagnosis and therapeutic approaches for both doctors and patients. It's often diagnosed on the basis of exclusion.
Those suffering from facial pain often undergo various repeated consultations with various specialists and end up receiving a number of treatments, including surgery. Many individuals and doctors mistakenly attribute facial pain and facial pressure as being caused by rhinosinusitis when, in fact, this isn't the case.
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What is Rhinosinusitis (Sinusitis)?
Rhinosinusitis, or a sinus infection, occurs when your nasal cavities become inflamed, infected and swollen.
Your sinuses are typically air-filled pockets in your facial bone. They're located:
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In your forehead
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Behind your eyes
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At the bridge of your nose
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At the apples of your cheeks
If they become blocked by fluid, bacteria or germ like viruses can multiply in these hard-to-reach, dark areas, causing an infection.
Sinusitis is typically caused by a virus and can persist even after the symptoms of an upper respiratory condition have disappeared. Sometimes, bacteria might cause a sinus infection. Other disorders can contribute to sinus symptoms and pain such as:
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Tooth infections
Is Sinusitis the Same as Sinus Infection?
The answer is essentially yes. Sinusitis is actually the same thing as a sinus infection. The term "itis" refers to swelling or inflammation often caused by an infection and "sinus" is the area of facial swelling.
How Long Does a Sinus Infection Last?
There are a couple of primary forms of sinus infections or sinusitis — acute and chronic.
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Acute sinusitis typically lasts between ten days and eight weeks, whereas, chronic sinusitis lasts longer than this.
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Chronic sinusitis is ongoing and might seem as if it's improving, but then it recurs with symptoms that can be just as bad as they were initially. Chronic sinusitis can last for months. Both acute and chronic sinusitis can be bacterial or viral.
From a clinical standpoint, it's important to distinguish between "sinogenic" and "non-sinogenic" facial pain to avoid the wrong treatment.
Distinguishing Between Chronic Sinusitis-Related Facial Pain and a Migraine?
Sinus infection headaches and migraines are simple to confuse because the symptoms and signs of both types of headaches might overlap.
Both migraine headache and sinusitis pain frequently become worse when you bend forward. Migraine can also be accompanied by a variety of nasal symptoms and signs, including:
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Facial pressure
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Congestion
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A watery, clear nasal discharge
Migraines are often misdiagnosed as sinus headache in around 42% of individuals because they share:
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Overlapping symptoms (nasal congestion, facial pain-fullness and rhinorrhoea)
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Common areas with chronic rhinosinusitis
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Precipitating triggers (allergies, weather changes and environmental irritants)
Also, migrainous and sinonasal conditions might often co-exist as comorbidities. Chronic rhinosinusitis might increase migraine-linked frequency and morbidity through aggravation of trigeminal nerve receptors.
Studies have found around 90% of individuals who visit their doctor for sinus headaches receive a migraine diagnosis instead. However, sinusitis typically isn't aggravated by bright light or noise or associated with nausea or vomiting — all common with migraines.
Sinusitis typically occurs after a cold or viral upper respiratory infection and includes:
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Discolored, thick nasal mucus
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Pain in upper teeth or one cheek
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Decreased sense of smell
Sinus infection-related headaches frequently last days or longer, whereas migraines often last hours to a day or two.
Sinus Infection and Facial Pain
So, is your facial pressure or facial pain due to a sinus infection? Pain is a common sinusitis symptom. You have a few different sinuses below and above your eyes and behind your nose. When you have a sinus infection, these can hurt.
Swelling and inflammation make your sinuses ache with dull pressure. You might feel pain:
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On either side of your nose
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In your forehead
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Between your eyes
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In your teeth and upper jaw
The relentless sinus infection and facial pressure and sinus swelling can cause headache symptoms. Sinus pain can also give you:
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Dental pain
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Earaches
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Pain in your cheeks and jaws
Sinusitis headaches are frequently worse in the morning since fluids have been gathering all night long.
Other Symptoms of Sinus Infection
Common sinus infection symptoms include:
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Nasal congestion or stuffiness
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Postnasal drip
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Coughing
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Discolored (greenish) nasal discharge
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Fever
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Pain in your teeth
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Tenderness of your face (especially at the bridge of your nose or under your eyes)
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Bad breath
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Fatigue
How is a Sinus Infection Treated?
First, you will need to find out what's causing your sinus infection. Is it bacterial or viral? If it's viral, it will not likely last more than a couple of weeks. To obtain relief from symptoms of a sinus infection, you can use:
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Topical and oral antihistamines
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Nasal decongestant sprays
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Nasal saline washes
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Nasal steroids
Antibiotics are often prescribed for bacterial infection. But, you don't want to jump too quickly to antibiotics because being overprescribed antibiotics can lead to you developing antibiotic resistance. Usually, allergists suggest you only take antibiotics if your symptoms have lasted over seven to 10 days. If medications don't work for you, your doctor might recommend surgery to correct defects in the bone that separates your nasal passages, open closed passages or remove nasal polyps.
How is Chronic Sinusitis Treated?
Treatments for chronic sinusitis include:
1. Medications
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Saline nasal irrigation: These include nasal solutions or sprays which reduce drainage and rinse away allergies and irritants.
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Nasal corticosteroids: These are nasal sprays that help treat and prevent inflammation. Some include budesonide, fluticasone and triamcinolone. If these aren't effective enough, the physician may suggest rinsing with a saline solution mixed with budesonide drops or using a nasal mist made from the solution.
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Aspirin desensitization treatment: If your body reacts to aspirin and it causes sinusitis, your doctor might have you take larger doses of aspirin, under their medical supervision, to increase your tolerance.
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Injected or oral corticosteroids: These are medicines used for relieving inflammation from severe sinusitis, particularly if nasal polyps is also present. Oral corticosteroids, when used long-term, can serious side effects, so they're typically only used for treating severe symptoms.
2. Antibiotics
Antibiotics, in some cases, are necessary to treat sinusitis if you're suffering with a bacterial infection. Your doctor may suggest an antibiotic, sometimes with other medicines, if they can't rule out an underlying infection.
3. Immunotherapy
If allergies are contributing to your sinusitis, immunotherapy (allergy shots) that help decrease your body's reaction to certain allergens may improve your condition.
4.Surgery
If your chronic sinusitis is resistant to medication or treatment, your doctor may recommend endoscopic sinus surgery. The doctor will use a flexible, thin tube with an endoscope (light) attached to explore your sinus passages during this procedure. Depending on the source of your obstruction, your doctor may use a variety of instruments for removing tissue or shaving away a polyp that's causing your nasal blockage.
Balloon sinuplasty, which is a minimally invasive outpatient procedure can improve sinus drainage, particularly if medications aren’t effective enough. Balloon sinuplasty can offer relief from chronic sinuplasty and is FDA approved.
Contact Houston ENT & Allergy Services
If you're wondering if your facial pain/pressure or other symptoms are related to a sinus infection or chronic sinusitis, give Houston ENT & Allergy Services a call. While we've become a large doctor group, we continue to treat every patient as though they're the only one we have. Contact us today to schedule your appointment with one of Houston’s most trusted and best ENT & Allergy Doctors.
