Monday, February 27, 2012

Paranasal sinus pain

Paranasal sinus pain

Pain in the sinus area, especially over or under the frontal or maxillary bones, is called sinus pain, which could be unilateral or bilateral. For instance, in case of maxillary sinusitis, pain is over the cheek. In case of ethmoidal or frontal sinusitis, pain is around or above the eyes. In sphenoidal sinusitis, the pain occurs in the rear of the eyes and center of the head.

True pain changes with changes in the day. For example, when patient wakes up, there is no pain. Pain starts in the morning and reaches to its peak in afternoon, and reduces in evening, and mostly absent in the night. This is called diurnal variation. Sinus pain generally worsens by nose blowing. If the pain is associated with sinusitis, the pain over the cheek exacerbates in the afternoon and by blowing the nose. Green mucus is released while blowing the nose. The pain related to nasal congestion improves in the night.
The pain generally resembles throbbing or pressure. Touching the affected sinus makes the pain worse. Since the pain may be associated with allergies, infections in the upper respiratory tract or chronic sinusitis, a visit to ear, nose and throat (ENT) doctor may be helpful. Maxillary teeth’s periapical dental abscesses, migraine headache, nasal polyps and temporal arteritis may mimic the pain. The pain may some times be due to inflammation of the nasal mucosa instead of sinusitis. Sinus pain is common during acute sinusitis and rare in chronic sinusitis.
During acute sinusitis, maxillary sinus pain is concentrated between the eye’s inner canthus and the molars or ears. Ethmoid sinus pain is located in the rear of the eyes and over the nose bridge. This pain some times rises with the movement of the eyes. The frontal sinus pain extends from the forehead to the temporal region and some times to the occiput (posterior of the head). Sphenoid sinus pain may be felt in various areas such as between the head and shoulder. In dentogenic maxillary sinusitis, the dental pain overpowers the sinus pain. The cheek may become sensitive to percussion and pressure.
The sinus pain is one of the common causes of facial pain. The ciliary mucosa of the paranasal sinuses is sensitive to inflammatory, traumatic, metabolic and neoplastic changes that may trigger pain. Change in the sinus pressure and in the pressure in the blood vessels supplying the sinus cause the pain. Bradykinin and other inflammatory agents stimulate endings of the sinus membrane nerves, leading to pain. Mucocele, mucous mass within in the paranasal sinuses, may trigger maxillofacial pain.

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