Dear Dr.
I am a 44-year old male. In 1991 I underwent surgery for a deviated septum, and then in 1992 underwent surgery for what I recall was a "sinusotomy". My symptoms were and are still a significant swelling sensation in the right side of my nose resulting in mild to what I would characterize as severe headache. Generally, I notice that the swelling occurs in only one side of my nose at a time and will usually "switch" sides every 3-4 hours. When the left side is swollen, I barely notice it. When the right side is swollen, it can be anywhere from mildly uncomfortable to unbearable - unbearable in terms of pressure and pain. I do experience some degree of head pain (centered almost exclusively around the orbit of my right eye) literally daily. In fact, there is very little time, period, that I spend pain-free.
I have been experiencing these symptoms for at least 8-10 years and the two surgeries provided only minor, if any, relief. I take Nasacort twice daily, but that medication does not abate my symptoms. In addition, I generally get 3-4 sinus infections annually - sometimes more.
I take Fiorinal on a daily basis and Fiorinal 3 and Vicodin at least 4-5 times a week. The only way these pain killers provide any relief is when my right side is "open". As a result, a great deal of the time, I am forced to open the passage with Afrin spray in order to gain relief.
Questions: Is this "side-to-side" nasal swelling unusual? Does it suggest any type of treatment? My surgeon sees me about every 2-3 months at which time I advise him that my condition is unchanged. While he has mentioned a partial turbinectomy, the last couple of times I saw him, my right side was only moderately swollen (purely coincidence). As a result, he is not recommending this procedure. I get a "fill-up" of medication and off I go!
I would appreciate any thoughts you might have relative to my symptoms and would be glad to answer any questions you may have.
Sincerely,
Reply: ------------------
It is uncommon that significant headache is related to a sinus and/or nasal condition as an isolated symptom (ie in the absence of other usual nasal/sinus symptoms such as nasal stuffiness, post-nasal drainage, nasal drip, alteration in sense of smell or taste, etc.). I advise caution when considering sinus or nasal surgery if headache is the only symptom because in this situation, studies have shown that the success of surgical therapy is not particularly great. Surgery would be indicated only if there were a clear anatomic finding that could be associated with the headache (CT scans are usually necessary); no other headache conditions are felt to be present (occasionally requires a consultation with a neurologist); and preferably the diagnosis of a "rhinogenic" headache has been confirmed by achieving resolution of an active headache with topical application of an anesthetic agent inside the nose. When non-surgical treatment modalities have failed (topical nasal steroids, decongestants, and antibiotics when infection is felt to be present), then surgical intervention may be considered. When headaches originally felt to be sinus- or nasal-related persist after successful surgical correction of anatomic abnormalties, I would suggest consideration of an alternative diagnosis for the headache which may require consultation with a neurologist.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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