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
Frequently Asked Questions
Persistent headaches after frontal sinus surgeries, especially those involving bone flaps, can be caused by nerve pain in the area due to damage to nerve endings. Approximately 10% of patients undergoing such procedures may experience this type of nerve-related pain, which can be challenging to treat but is manageable with appropriate therapies.
Yes, nerve pain from sinus surgeries can be treated using medications specifically for nerve pain, anesthetic injections, and steroids targeted at the affected nerve region. In more severe cases, surgical options such as nerve root cutting by a neurosurgeon may be considered, although these are more invasive approaches.
Vestibular Neuritis is an inner ear condition typically caused by a viral infection that inflames and damages the balance nerve. This leads to balance issues, as seen when one ear must compensate for the other. Additionally, the condition can worsen headaches, and symptoms may temporarily worsen with fatigue or stress.
Balance problems caused by Vestibular Neuritis can often be improved with vestibular therapy, a rehabilitative treatment that helps the brain adjust to the damaged nerve and compensate for balance deficits. This therapy is effective for most patients, although symptoms may worsen occasionally under stress or illness.
Symptoms worsen with stress or illness because the brain's learned adjustments to the damaged balance nerve become less effective under these conditions. Stress and fatigue can temporarily interfere with the brain's ability to compensate, causing a return or increase of balance difficulties and associated symptoms.
Yes, modern minimally invasive procedures like image-guided endoscopic surgery and balloon sinuplasty are preferred today, which reduce the risk of nerve damage and persistent pain. Radical procedures such as removing the frontal sinus bone flap are now rare and performed only when necessary, such as for severe infections.
Although some nerve damage may be permanent, both persistent sinus surgery-related headaches and balance issues from Vestibular Neuritis can be managed and improved with medication, therapy, and sometimes surgery. Complete resolution depends on individual cases, but many patients achieve significant symptom control.
