Is Sinusitis Likely Causing Bilateral Facial Pain and Other Symptoms?

Is it highly likely that sinusitis can cause bilateral tenderness in the cheeks and in front of the ears?

My symptoms are as follows: 1.
Bilateral tenderness in the cheeks in front of the ears and pain in the upper jaw, with a sensation of pressure in both cheeks, as if someone has punched my face, or like being heavily pressed on both sides of the cheeks.
Sometimes the symptoms alleviate, but at times they worsen, especially at night when the tenderness is most pronounced, with the greatest pressure sensation in the area in front of the ears.
2.
Persistent cough with an itchy throat; the coughing frequency is not high, but sometimes talking or eating triggers an itchy throat that makes me want to cough.
When I do cough, it can lead to slight muscle spasms, almost like I'm about to vomit, producing a "oh-oh" sound.
3.
White phlegm and translucent nasal discharge.
I noticed that phlegm associated with sinusitis is usually yellow or green, so I'm wondering if white phlegm makes sinusitis less likely? 4.
Pain in the upper molars, specifically the second-to-last tooth on the left upper row and the last tooth on the right upper row.
The pain comes and goes, but it is particularly intense when chewing or applying pressure.
I have seen a dentist; one tooth was recently filled, but it still hurts.
The dentist said there was no nerve damage, so there’s no need for a root canal on the other tooth, which had a root canal done three years ago and had not hurt for a long time, but recently both have been hurting at times.
5.
Nasal congestion is not significant; I only experience unilateral nasal congestion when lying on my side.
6.
I used to not be afraid of cold weather, but recently I have been feeling cold.
7.
Slight numbness in the upper back.
8.
Occipital nerve pain accompanied by neck pain.
9.
Normal sense of smell; I do not detect any fishy odors.
I visited an ENT specialist a month ago, and the doctor said my nasal condition was fine, but my throat was inflamed, and prescribed a cough syrup containing licorice.
However, the cough has persisted until now.
I am wondering if I should wait for the illness to run its natural course or if I should see an ENT doctor again? Is blood work necessary? Alternatively, would it be better to consult a pain specialist regarding the symptoms of facial pain, tooth pain, and shoulder and neck pain to identify the underlying issue?

Yao, 30~39 year old female. Ask Date: 2019/12/22

Dr. Ji Zhaoyun reply Otolaryngology

Hello, common symptoms of sinusitis include nasal congestion, yellow-green 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.
If acute sinusitis persists despite antibiotic treatment for more than two weeks, it is recommended to consult an otolaryngologist for bacterial culture.
If "more virulent" bacteria are identified, it may be necessary to switch to a stronger antibiotic.
It is advisable to purchase a "nasal irrigation device" (containing isotonic saline) and perform rinsing 1-2 times daily to enhance the treatment effect of sinusitis.
Additionally, avoid staying up late, refrain from smoking, and individuals with diabetes should control their blood sugar levels.
If treatment exceeds 2-3 months and sinusitis remains unresolved, it is highly likely to be "chronic" sinusitis, requiring further examination.
If necessary, surgical intervention may be needed, and it is recommended to seek evaluation from an otolaryngologist.
In addition to medication, daily life precautions include avoiding lying flat for two hours after eating and steering clear of coffee, tea, cigarettes, alcohol, fried foods, and spicy foods, as these can help improve symptoms.
Wishing you peace and good health.
Sincerely, Dr.
Chi Chao-Yun, Head of the Department of Otolaryngology, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2019/12/22

More Info

Sinusitis, or inflammation of the sinus cavities, can indeed lead to a variety of symptoms, including bilateral facial pain, which you are experiencing. The pain you describe in your cheeks and the area around your ears could be attributed to sinus pressure and inflammation affecting the surrounding tissues. This is particularly common in cases of sinusitis, where the sinuses become swollen and filled with fluid, leading to discomfort and pain that can radiate to other areas of the face.

Your symptoms suggest a complex interplay of issues. The bilateral facial pain, described as a feeling of pressure or being hit, is characteristic of sinus-related pain. Sinusitis can cause referred pain to the teeth, especially the upper molars, due to their proximity to the maxillary sinuses. This could explain the pain you feel in your upper teeth, even after dental evaluations have ruled out other dental issues.

The presence of a persistent cough and throat irritation could also be linked to post-nasal drip, a common symptom of sinusitis, where mucus drips down the back of the throat, leading to irritation and coughing. The white or translucent mucus you mentioned does not rule out sinusitis; while yellow or green mucus is often associated with bacterial infections, clear or white mucus can still indicate inflammation or viral infections.

Your mention of experiencing increased pain at night and a feeling of coldness could suggest that your body is reacting to inflammation. The discomfort in your upper back and neck, along with occipital nerve pain, may also be related to tension or referred pain from the sinus area, as the head and neck are interconnected in terms of nerve pathways.

Given that you have already consulted an ENT specialist who noted inflammation in your throat but found your nasal passages to be in good condition, it may be worth considering a follow-up appointment. If your symptoms persist or worsen, further evaluation may be necessary. This could include imaging studies, such as a CT scan of the sinuses, to assess for any underlying issues that may not have been visible during your initial examination.

As for whether you should wait for the condition to resolve naturally or seek further medical attention, it largely depends on the severity and persistence of your symptoms. If you find that your pain is significantly impacting your quality of life, or if new symptoms arise, it would be prudent to seek further evaluation. Blood tests may not be necessary unless there are signs of systemic infection or other underlying conditions.

Visiting a pain management specialist could also be beneficial, especially if your symptoms are multifaceted and involve chronic pain. They can help identify the source of your discomfort and provide targeted treatment options.

In summary, while it is possible that sinusitis is contributing to your facial pain and other symptoms, the complexity of your case suggests that further evaluation may be warranted. Keeping an open line of communication with your healthcare providers and advocating for your health will be key in finding relief.

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