What are the signs and symptoms of facial pain due to acute sinusitis?

Updated: Jan 29, 2020
  • Author: Tejas Raval, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

Patients with facial pain secondary to acute sinusitis have coexisting symptoms such as nasal obstruction, hyposmia, or purulent nasal discharge and have endoscopic signs of disease such as purulent drainage, inflammation, and edema. [10, 11]

Pain severity and radiographic disease severity are not related in patients with sinusitis. [12]

Jones et al found that in 679 patients with presumed sinusitis, pain was the presenting symptom for only 119 (18%). Of these patients, 25% had no endoscopic or CT findings of sinusitis. [13]

Treatment of acute sinusitis consists of antibiotics with systemic or topical decongestants, analgesics, and aggressive hydration. Antibiotic treatment usually consists of amoxicillin or a macrolide antibiotic for 10-14 days. Patients who are poorly responsive, have continued disease at the end of treatment, and those with acute-on-chronic sinusitis may need treatment with second-line medications such as amoxicillin/clavulanate, second- or third-generation cephalosporins, fluoroquinolones, or clindamycin.

Endoscopic sinus surgery (ESS) should be considered for chronic rhinosinusitis in which medical therapy has failed. Studies have shown that facial pain and pressure improve in 56-77% of patients after ESS. Some studies have also reported improvement in facial pain in patients who undergo ESS for nonsinogenic headache and facial pain. However, most of these patients have recurrence of pain within 9 months. [14]


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