Question: My husband has had persistent pain after sinus surgery in April 2007. Three days later, he had staph in his sinuses. It took 4 months to treat it. November 2007, he got staph in his sinuses again. This time, it took 5 months (April 2007) to treat it. His ENT says his sinuses now look great, that there is nothing else he can do. Is there a possibility that he has nerve damage from the staph? He hasn’t had any major infections since the last staph. He does have allergies, but we were told they were minor.
He is in constant pain 24/7. He says it is like a deep pain, as if someone is hitting his bone/sinuses with a “pick hammer”. He has been checked for osteomyelitis too, but nothing showed up. The pain is located in every sinus area except the left frontal sinus (he was born without it). We just don’t know where to go next…we are desperate. Any suggestions would be greatly appreciated Thank you!
Answer:
Thank you for writing to us. Unfortunately I can’t give you a diagnosis of your husband’s specific medical problem and can only answer in general. As always, direct medical care is essential.
Constant facial pain after sinus surgery is unusual. There are many different possibililties, including facial pain syndromes, temperomandibular joint problems, and other neurologic pain. There may well be something actually irritating his nasal and sinus mucosa- which should be evaluated if this has not been done. We have had patients with chemical sensitivities causing such a problem, and quite often gastro-esophageal reflux, i.e. stomach acid, that comes as high as the nasal passages and sinuses can cause burning pain. Once problems such as osteomyelitis, tumor, or persistent infection have been ruled out, one should be evaluated for these other issues. He should consider pH testing, either with a probe at the upper part of the food pipe, esophagus, or a newer evaluation (Restech) that measures acidity in the back of the nose.
Robert L. Pincus MD
NY Sinus Center
Frequently Asked Questions
Persistent facial pain after sinus surgery is unusual but possible. It may be caused by complications such as nerve damage, infections, or other facial pain syndromes. Proper evaluation by an ENT specialist is essential to identify the underlying cause.
Nerve damage from staph infections in the sinuses is a potential cause of persistent pain, especially if infections were severe or recurrent. However, diagnosing nerve damage requires thorough neurological evaluation and cannot be confirmed without specialist consultation.
If infections, tumors, or osteomyelitis are ruled out, other causes such as facial pain syndromes, temporomandibular joint disorders, chemical sensitivities, and gastro-esophageal reflux may be responsible. Comprehensive evaluation including pH testing might be needed.
Gastro-esophageal reflux can cause stomach acid to reach the nasal passages and sinuses, resulting in burning pain and irritation. Testing for acid levels in the esophagus or nasal cavity can help determine if reflux is contributing to sinus pain.
After excluding infections or tumors, tests like pH probe monitoring in the esophagus or the Restech system, which measures acidity in the back of the nose, can be used to detect acid reflux contributing to sinus irritation.
If the sinuses appear normal on examination, further evaluation for other causes of pain such as nerve-related issues, TMJ problems, chemical sensitivities, or acid reflux should be pursued. Multidisciplinary care may be necessary to identify the pain source.
