Sinus Pain (Painful Sinusitis) – Location, Causes and Treatment

Sinus pain is a common nose-related problem and usually indicates that the sinuses are inflamed. Most of the time this is due to an infection, which often starts with the flu or a common cold and continues thereafter. Sinus pain can contribute to headaches and eye pain. It can also affect a person’s ability to concentrate and function on a daily basis. However, the pain is only a symptom of some underlying sinus and nasal condition.

The paranasal sinuses are connected to the nasal cavity. Air that flows into the nasal cavity can also fill the paranasal sinuses as can mucus and fluid which can move from one cavity to the other. The mucosal lining of the paranasal sinuses are continous with that of the nasal cavity. This mucosa produces mucus which keeps the lining moist and also traps dust and microbes which are then expelled.

However,  pollutants, dust and microbes from the environment can irritate or infect the sinuses. This causes excessive mucus production, swelling, tenderness and pain. Any obstruction of the paranasal sinuses may also pain as the sinuses become congested with mucus which cannot drain out properly. There may also be other symptoms apart from pain, depending on the cause of sinusitis.

Read more on congested sinuses.

Location of Sinus Pain

There are four pairs of paranasal sinuses which connect to the nasal cavity. This includes:

1. Frontal sinuses which lie in the forehead, just above the middle of the eyebrows.
2. Maxillary sinuses which are located in the upper jaw on either side of the nose.
3. Ethmoid sinuses which lie on either side of the nose bridge between the eyes.
4. Sphenoid sinuses which lie towards the back of the nasal cavity.

Based on the location, pain of the paranasal sinuses may therefore be felt at specific areas of the head as a result of inflammation or congestion. Therefore pain with other sinus symptoms may be felt in the:

• Forehead, just above the eyes.
• Bridge of the nose next to the inner eyes.
• Cheek or upper jaw.
• Nose, palate or throat.

However, there are instances where the pain may not present in this typical location. A person may complain of a generalized headache where pain is felt over the entire head rather than localized to a specific region. Furthermore with some conditions like a common cold, the headache that is usually present may not always be due to inflamed sinuses.

Other Symptoms

Sinus pain is a symptom. It is described as an ache of pressure or congestion in the affected area. Often there is a headache, with the pain being focused in the area where the painful sinus lies. Eye pain and earache may also be reported with the sinus pain. Apart from the pain there may be other signs and symptoms such as:

• Runny nose and/or postnasal drip
• Difficult nasal breathing
• Congested nose
• Tenderness and swelling of the area over the affected sinuses
• Impaired sense of smell and taste

A fever may also be present in the event of an infection and postnasal drip can lead to throat irritation with a cough. It is important to note that sinusitis may be present without any pain over the paranasal sinuses. It is also possible that the other symptoms may not be present despite a person having a sinus headache.

Read more on sinus pressure headache.

Causes of Painful Sinusitis

The causes of painful sinusitis are the same as the causes of acute and chronic sinusitis since pain is present in both instances. In addition, trauma to the head over the area of the sinuses may also result in pain. This may be due to the injury itself but can also exacerbate pain in an underlying sinus problem. However, there is also a possibility of other causes of a headache after traumatic head injury which needs to be considered as it can be life threatening.

Allergies

Allergies are a common cause of sinusitis. Allergic rhinitis is inflammation of the nasal passages due to a hypersensitivity mainly to substances like dust and pollen.  This can be a cause of acute and chronic sinusitis as the inflammation of the nasal mucosa extends to the paranasal sinuses. There may be a seasonal flareup or inflammation may extend throughout the year with periods of flareups.

Infections

Common viral infections that affect the nose, like the common cold, may also cause sinusitis. Usually this is short lived and resolves on its own without treatment. However, sometimes it may be followed by secondary bacterial infections which then needs treatment. Fungal infections of the sinuses are less common but can be responsible for certain cases of chronic sinusitis.

Read more on fungal sinusitis.

Blockages

Nasal polyps are being growths in the nasal cavity. These growths can sometimes obstruct the paranasal sinuses which then hampers mucus drainage thereby leading to sinus congestion. A deviated septum is another possible cause of a blockage in the sinuses. Apart from congestion due to poor drainage these obstructions may also increase the risk of infections arising in the sinuses.

Other causes

• Gastroesophageal reflux disease (acid reflux)
• Cystic fibrosis
• HIV infection
• Immune disorders

Treatment of Sinus Pain

The underlying cause of sinus pain should be treated in order to ease symptoms like pain. Therefore treatment is directed at the sinus inflammation and/or sinus congestion. This may involve the use of:

• Nasal sprays – saline, decongestant or corticosteroid sprays.
• Antibiotics for bacterial infections.
• Antihistamines for allergies.
• Immune therapy for allergies.
• Corticosteroid (oral or injection) for inflamed sinuses.
• Pain relievers like acetaminophen and ibuprofen for sinusitis pain.

In the event of allergic sinusitis it is also important to avoid triggers (allergens) as far as possible to prevent an acute flareup. Surgery may be necessary in some cases of chronic sinusitis. The procedure is known as functional endoscopic sinus surgery (FESS). It helps to unblock the sinuses and removes some sinus tissue which further eases mucus production and congestion. This procedure needs to be done by a surgeon (ENT or otorhinolaryngologist) when medical treatment alone is not yielding the desired results.