Facial pain, tightness, blockage

[GLAPS]

My brother has been having problems with facial pain, seemingly liked to his nose and sinuses, which has been going on for about 4 years now.

He had plastic surgery on his nose to correct a raised bump in his nose around 10 years ago. We don’t know whether this had anything to do with the pain he has been having but there was quite a bit of time in-between the surgery and the pain starting.

Its limited to the right-hand side of the face and the pain seems to be centred almost behind the tear duct, if not slightly below and towards the nose.

He has had several treatments over the last few years including grommets, nasal surgery, turbinectomy etc. but the pain is still there.

The pain is intermittent although he constantly has a tight sensation in his face/nose and squirts water up his nostril (right only) which he then blows out to help clear the feeling - this mainly drains through the left nostril though. He can go a few days without pains and then some days get 2 or 3 in a night, some resulting in him being sick from the pain.

He has found that keeping cool minimizes the amount of pains he gets but does mean he is sat in front of an industrial fan most of the day and all night – this is obviously preventing him from working or getting proper sleep. The thought behind being cool is that the pain is a result of swelling in the nasal cavity/sinuses that presses against a nerve or something and keeping cool means the swelling doesn’t happen. He can take Sumatriptan tablets, which help reduce blood vessels, and these seem to work but he's limited to 8 a month.

The feeling he has is that there is a blockage or the nasal valve in the right nostril has collapsed or malfunctioned. He can’t breathe properly out of this side therefore mucus builds up in the sinus and has nowhere to go. He recently had a swab on the mucus build up in his nose, which showed an infection. This has since cleared but he still gets the pains - all suggesting a blockage/ventilation being the problem. When he blows his nose, his right ear squeaks suggesting the air is forced out his ear rather than his nose.

His most recent surgery was in February/March. This included a second turbinectomy, widening the nasal opening, clearing the sinuses and a balloon sinuplasty. Initially the onset of the pains subsided and he went nearly 4 weeks without a pain, although the tight feeling remained and he had to stay cool to keep them at bay. They have since returned to how they were, suggesting either the surgery didn’t work, some of the work carried out has since 'failed' or the build-up of mucus has begun again.

What my brother has suggested is that he wants the mucus build up cleared, the valve within the right side of his nostril/sinus 'fixed' to allow him to breathe out properly along with any other possible blockage in the ear cleared. This he feels will hopefully stopping the mucus build up and pressure that we believe is leading to the pains.

Anything anyone can suggest in terms of initial diagnosis of the symptoms, thoughts from people who have experienced similar things, what treatments are potentially available etc. would be a great help.

[Paderla Anitha, DNB]

Hello and hope you are doing well.

If he has a  chronic sinus infection, typical antibiotic treatment is for 4-6 weeks.  A nasal steroid spray is also beneficial as well as oral steroids.  Nasal saline irrigations over the counter like NeilMed or Neti pot are very effective.  The best diagnosis for this problem is a CT of the sinuses. Surgery is recommended to patients that fail maximal medical treatment.

Hope this helped and do keep us posted.

[GLAPS]

Thanks for the reply Dr Anitha

He has had several CT scans, taken 8 weeks of antibiotics and a number of surgical procedures, all of which dont seem to have helped.

He believes there is a blockage somwehere, causing this mucus to build up and get infected. Do you have any advice of where/how a blockage like this can occur and the possible treatment/surgery?

Thanks

[GLAPS]

These are all the medicinces my brother has been given over the last 4 years in alphabetical order. The only thing that seems to work in any way are the Sumatriptan tablets, presumably because they shrink the blood vessels meaning he doesnt get the swelling and therefore no pain.

ALLEGRON (anti-depressant)
AMITRYPTILLINE
AMOXICILLIN (anti biotic)
AUGMENTIN (anti biotic)
AVARNYS (steroid spray for sinus)
ERMAX (erythromycin) anti biotic for sinus
AZITHRONYCIN (steroid)
CO CODRAMOL pain killer
CLARITHROMYCIN anti biotic
CIPROFLOXACIN anti biotic
DELTACORTRIL steroid
DIHYDROCODEINE pain killer
DOXYCYCLINE anti biotic
FLIXONASE nasal congestion
GABAPENTIN nerve damage
IBUPROFEN pain killer/inflammation
IMIGRAN (like Sumatriptan) Migraine
INDOMETACIN muscular skeletor inflammation
LYRICA nerve damage
MORPHINE SULPHUR  pain killer
NORTRIPYLINE
OROMORPH oral morphine pain killer
OXYNORM
OXYCODONE HYDROCHLORIDE
PREGABLIN
PREDISOLONE steroid
SECURON high blood pressure
SUDAFED nasal/sinus congestion
SUMATRIPTAN migraine - Reduces blood vessels
TEGROTOL (carbamazepine) pain killer for Trigeminal Neuralgia
VERAPAMIL HYDROCHLORIDE pain killer
ZYDOL pain killer
VISTANEHASONE nasal drops

He has Pancreatitis, plus had a heart murmur/irregular beat when he was younger (heart stopped when a baby too) so his GP has told him to only take 8 Sumatriptan tablets a month. These tablets are 100mg and the only thing that prevent the pains – is there another drug that does the same thing (shrink the blood vessels) that he could take more often (one a day) to prevent the pains while we search for a cure?

He has looked things up on the internet and found - OXYMETAZOLINE. PHENYLEPHRINE.  ZYLOMETAZOLINE. NAPHAZOLINE. Could he take these daily instead?

[Paderla Anitha, DNB]

Hello and hope you are doing well.

Without a proper diagnosis, it may not be advisable to take medications. There could be other issues like a polyp or deviated nasal septum, causing his symptoms of a nasal blockage. Sometimes chronic allergies can also cause nasal stuffiness and difficulty breathing. Please discuss this with your doctor am sure he will provide further assistance. In the meantime for relief from his symptoms he could do steam inhalations and take OTC antihistamines.

Hope this helped and do keep us posted.