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Ear, Nose, and Throat Disorders

Nerve pain in upper nasal cavity

02/03/2010

Question:

To Dr. Seiden:

I suffer from debilitating chronic pressure pain located somewhat behind the nose, at eye level. The pain is dull and prostrating and has lasted many years. It is dramatically reduced with lidocaine injection in middle turbinate or with topical lidocaine inside nose. It responds well to TENS of nasal nerve. But the weirdest thing is that pressing the nasal walls outwards with cotton swaps eliminates the pain. (I am of course advised not to do this because of the risk of fracture of orbital walls.) I have seen some 10 ENTs and I`ve had middle turbinate reduction and FESS done twice. Middle turbinates are still in place but I doubt that my symptoms stem from the remaining contact points and septal adhesions. I think my pain originates somewhere further up, perhaps in the ethmoid cells.

Where on earth do I find a specialist who has seen nerve pain in this area? Do they exist at all? One "contact point headache" specialist I saw proposed to basically take it all out, middle turbinates and various other stuff, but I doubt I am actually suffering from middle turbinate headache.

I am currently treated by caring and experienced specialists and they are very puzzled about this situation. They would love input, too, on my case I think. So I`m writing to throw the net as far as possible. Perhaps you`ve heard of such cases? Some of the best ENT departments in this country have little to offer when it comes to nasal nerve pain --- this I`ve learned from own experience, but I`m still hoping to find a doctor who can help us with this exceptional problem.

Thank you,

Pain-in-the-head

Answer:

Since your pain responds to anesthetic in the nose, or pushing your nasal side walls outward, it would seem you do have contact headaches.  However, in that case your multiple surgical procedures should have been more effective.  I don't think it is a good idea to "empty" your nose.  There are specialists who treat various causes of facial pain, with various nerve blocks, medications, etc.  There is one such person at the University of Cincinnati, but I'm sure there are others. 

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Response by:

Allen M Seiden, MD Allen M Seiden, MD
Professor of Otolaryngology, Director of Division of Rhinology and Sinus Disorders, Director of University Taste and Smell Center, Director of University Sinus and Allergy
College of Medicine
University of Cincinnati