Since suffering from a series of stubborn sinus infections over the past several years the nature of my allergic reactions has changed. Where formerly I suffered nasal congestion, itchy eyes, sneezing, etc., now my main reaction is massive sinus pain with few of my previous symptoms. I am currently in the first stages of receiving allergy shots, and have kept symptoms marginally under control by staying indoors as much as possible and by use of prescription decongestants and Beconase. However, any outdoor activity results in intense sinus pain within 24 hours which lasts about 48 hours before gradually diminishing over the next several days. The usual pain killers (aspirin, ibuprofen, Tylenol) have no noticeable effect on this pain, at least when it is at its peak.
Two questions:
1. Is there anything I can do or take to avoid triggering this
reaction when I must be outdoors?
2. Is there any way get relief from this pain other than to wait for
the decongestants to catch up with the swelling?
Thank you.
Reply ---------------------------------
The symptom you describe is an unusual manifestation of allergy but certainly within the realm of possibility. If indeed allergy is the underlying cause, it presumably is related to intermittent obstruction of drainage channels leading from the various sinuses into the nasal passage caused by allergic swelling of the mucosal lining of the nose and sinuses. The medications that most likely would provide the most benefit and least risk would be 1) nasal steroids such as Beconase, Flonase, Nasacort, Rhinocort, Vancenase, etc. and/or 2) decongestants or decongestant/antihistamine compounds. Nasal steroids most likely would have the least side effects as well as the most overall benefit, but they would need to be used daily throughout the allergy season. Non-steroidal anti-inflammatory agents such as ibuprofen, naprosyn, etc. would also likely provide significant benefit. A more long term solution would be desensitization with allergy shots, but this would not provide short term help.
If these measures listed above were given adequate trials and they did not result in adequate improvement, then I would consider a CT scan of the sinuses to study the anatomy of the sinus drainage pathways. If they were significantly narrowed or chronically obstructed, consideration might be given towards endoscopic surgery to enlarge the openings, but this should be considered only as a last resort and after other potential causes of such pain have been ruled out. Also deviations of the nasal septum can also rarely cause such pain and they can be easily repaired in most cases surgically. Before considering more aggressive intervention of this nature, I might consider an opinion by a neurologist regarding your facial pain to rule out other possibilities such as facial migraine, cluster headache, etc.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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