Persistent Eye Pain and Ear Congestion: Seeking Answers in ENT Care

Eye pain, ear fullness, and sensitivity to loud sounds?

Hello Doctor, I have been seeing doctors, but it seems that no one can piece everything together.
I am experiencing pressure and pain in the upper part of my eyeballs and between my eyebrows, along with a feeling of ear fullness (both ears and eyes are affected equally).
The symptoms are most severe right after waking up, and I feel fatigued throughout the day, with many issues similar to chronic sinusitis.
In early October, I underwent functional endoscopic sinus surgery (FESS) for maxillary sinusitis and partial resection of the middle turbinate (the CT showed that it was overly developed, and the surgeon decided not to operate on the superior turbinate due to its high position).
It has been about two weeks since the surgery, and I have undergone local treatment to clear the crusting.
The yellow nasal discharge has resolved, but the pressure and pain in the upper part of my eyeballs, between my eyebrows, and the ear fullness persist (both ears and eyes are affected equally), and I still feel fatigued throughout the day.
Currently, there are not many foreign bodies when I rinse my sinuses, but I still feel fluid in the sinuses.
If I make larger movements, I experience slight pain above my teeth where the maxillary sinus is located.
I am still on antibiotics.
After the surgery, I consulted an ophthalmologist again, who said my intraocular pressure is normal and there is no glaucoma.
My tear production has decreased a bit, but artificial tears and warm compresses have not provided any relief.
I have previously sought medical attention for a long time, including an MRI of the brain, psychiatric evaluation, and dental check-ups, all of which showed no issues.
Pain relievers and muscle relaxants have not been effective.
Even though I have severe obstructive sleep apnea (OSA), it should not cause symptoms of this magnitude.
An ENT specialist also found it strange that during drug-induced sleep endoscopy (DISE), my nasopharynx (the area behind the inferior turbinate) was only narrow and not completely obstructed, but when I am awake and relaxed, whether sitting or standing, there is a circumferential obstruction in the nasopharynx, especially during exhalation, where it can completely close temporarily.
The doctor mentioned that the position is too high to be surgically addressed.
I would like to ask if I still have issues with sinusitis or hyperplasia of the superior turbinate, as my symptoms are very clear: pressure and pain in the upper part of my eyeballs, between my eyebrows, and ear fullness (both ears and eyes are affected equally), with the worst symptoms right after waking up and persistent fatigue throughout the day.
Are there any other specialties or tests I should consider to confirm this? Thank you.

JS, 40~49 year old female. Ask Date: 2018/10/21

Dr. Ji Zhaoyun reply Otolaryngology

Hello, common symptoms of sinusitis include nasal congestion, thick yellow nasal discharge, fever, facial pain, foul smell, and changes in smell, although not all symptoms may be present.
Diagnostic methods include endoscopy and imaging studies.
The symptoms you mentioned are not typical.
If symptoms persist, it is advisable to consult your original physician again or bring all previous examination records to an otolaryngology specialist for evaluation.
Wishing you health and safety.

Sincerely,
Dr.
Chi Chao-Yun,
Department of Otolaryngology, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2018/10/21

More Info

It sounds like you are experiencing a complex set of symptoms involving persistent eye pain, forehead pressure, and ear congestion, which can be quite distressing. Given your history of sinus surgery and ongoing symptoms, it’s important to consider several factors that could be contributing to your discomfort.

Firstly, the symptoms you describe—pressure in the upper eye area, forehead pain, and ear congestion—are often associated with sinus issues, particularly chronic sinusitis. Even after surgery, it is possible for inflammation or blockage to persist, leading to fluid accumulation in the sinuses, which can cause pressure and pain. The fact that your symptoms are worse upon waking suggests that mucus may be pooling overnight, leading to increased pressure in the sinuses and potentially affecting the eyes and ears.

You mentioned that you have undergone a Functional Endoscopic Sinus Surgery (FESS) and had part of your middle turbinate removed. While this surgery can provide relief, it does not guarantee that all symptoms will resolve immediately. Sometimes, it can take time for the sinuses to heal and for inflammation to subside. Additionally, if there are anatomical variations or residual inflammation, these could contribute to ongoing symptoms.

The sensation of ear congestion can also be linked to Eustachian tube dysfunction, which may occur if the tubes that connect the middle ear to the back of the throat are not functioning properly. This can happen due to inflammation or blockage, leading to a feeling of fullness or pressure in the ears, which can be exacerbated by sinus issues.

Given that you have already consulted with an ENT specialist and have had imaging studies like an MRI, it may be beneficial to revisit your ENT for a thorough evaluation. They may consider performing a nasal endoscopy to directly visualize the nasal passages and sinuses, checking for any residual blockage or inflammation that could be causing your symptoms. Additionally, they might assess the Eustachian tubes to determine if they are functioning properly.

In terms of self-care, continuing to use saline nasal sprays or rinses can help keep the nasal passages moist and may assist in clearing out any mucus. Staying hydrated and using a humidifier can also be beneficial. If you haven’t already, consider discussing the use of nasal corticosteroids with your doctor, as these can help reduce inflammation in the nasal passages and sinuses.

Regarding your concerns about the potential for chronic issues, it is understandable to feel anxious about the possibility of long-term symptoms. However, many patients experience gradual improvement over time, especially with appropriate management. It’s crucial to maintain open communication with your healthcare providers and to advocate for further evaluation if your symptoms persist or worsen.

In summary, your symptoms may be related to ongoing sinus issues, Eustachian tube dysfunction, or a combination of both. A follow-up with your ENT specialist for further evaluation and possibly additional imaging or procedures may be warranted. In the meantime, continue with supportive care measures and monitor your symptoms closely. If you experience any new or worsening symptoms, such as changes in vision, severe pain, or fever, seek medical attention promptly.

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