Question: I have had numerous sinus surgeries – I have even had the sinus cavity in my forehead removed and filled in with artificial bone material. I have have been cut so many times in my eyebrow area and as a result, I now have persistent post-sinus surgery headaches. I continue to have severe headaches every day. I have been told that my headaches come from the damage to the nerve endings in my head due to so many sinus surgeries. About four years ago I developed Vestibular Neuritis – my right ear now controls the balance for my body – but this has made my headaches worse and if I get very tired or stressed my balance issue becomes worse. My life has totally been affected by all of this – I go to work and back home – I cannot stand to be in a crowd or hear loud noise – I have been to several ENT, and ear specialists and even the head of the ENT at Southwestern Medical in Dallas and they all say the same thing – I will have to suffer from this the rest of my life.
Answer:
Thank you for your question. You really have at least two problems that affect each other. While both are troublesome and difficult, neither is impossible to manage.
Headaches can often be from sinus problems- but other issues can cause headaches as well. However, about 10% of people who have had bone flaps for their frontal sinuses wind up having persistent nerve pain in the area. With today’s minimally invasive procedures- such as image-guided endoscopic surgery and balloon sinuplasty- that procedure is rarely done, except for a persistent bone infection (0steomyelitis) of the skull. If the infection has resolved, the pain may be treated with medications for nerve pain and sometimes with an anesthetic injection and steroids into the area of the nerve. Sometimes the root of the nerve causing the pain can be cut- although this may require a procedure from neuro (brain) surgeon.
One can have damage to the balance nerve from many sources- the most common cause, we believe, it may be from a viral infection that damages the nerve. Sometimes, the damage is permanent- however, in general, the brain and the inner ear learn to readjust. I am not sure how long this has been a problem, but if persisting, we recommend balance (vestibular) therapy, which helps in most people. Frequently, when ill or under other stress, this learned readjustment can stop working well. That would cause the symptoms to temporarily, to recur.
It is imperative, of course, that other causes of imbalance have been checked for, and ruled out.
I hope this helps clear things up a bit.
Robert Pincus MD
Co-director NY Sinus Center
