TREATMENT OF CHRONIC PARANASAL SINUS PAIN WITH MINIMAL SINUS DISEASE

A common problem for otolaryngologists are patients who present with r ecurrent, persistent sinus pain that appears out of proportion to the findings on physical examination. Often these patients have a history of recurrent sinusitis that required antibiotics or surgical intervent ion. Many have had repeated surgical procedures because of this pain. Other common past medical histories may include allergic rhinitis, fac ial trauma, or dental disease. Patients who have experienced documente d acute sinusitis in the past will often present de novo with similar symptoms, but lack any objective evidence of a new active sinus infect ion. However, the diagnosis of sinusitis is not clearly removed from t he patient's or clinician's mind, and the patient is further frustrate d by the lack of adequate diagnosis, treatment, and resolution of symp toms. These patients may or may not be experiencing an upper respirato ry tract infection or allergy with nasal drainage. Often, they are emo tionally distraught from recurrent and persistent pain, the lack of re solution of their symptoms, dependency on narcotics and other analgesi cs, multiple consultations with a variety of clinicians, and the impin gement of their symptoms on employment, interpersonal relationships, a nd societal and family obligations. If sinusitis is not found to be pr esent, the otolaryngologist must help the patient understand this poin t, reassure him or her that the otolaryngologist will still be vigilan t for the development of sinusitis, and refocus the history and workup for some other cause of the recurrent and persistent paranasal pain. We review various treatment approaches to paranasal pains that are not the result of sinusitis.