Dr. Howard Levine talks “SINUS PAIN”

Dr. Howard Levine talks “SINUS PAIN”

September 18, 2018

By Howard Wolinsky, a healthcare blogger

Howard L. Levine, MD, an expert in nasal and sinus disorders, at the Cleveland Nasal Sinus and Sleep Center examines patients daily who often are complaining of “sinus pain.” But just because his patients think that’s the problem, it may not be the case at all. “Patients relate most things that occur in and around the face to the sinuses because people are aware of the sinuses being in the face,” observes Levine, an ENT (Ear, Nose and Throat) specialist and past president of the American Rhinologic Society (ARS).

The sinuses are cavities in the bones of the face or skull connecting with nasal cavity. They produce a mucus layer that protects the nose from pollutants, micro-organisms, dust and dirt. About 15% of Americans see doctors for sinus issues, according to the American Rhinologic Society. And many others simply live with the discomfort.

In evaluating his sinus patients, Levine asks them to describe the nature of the discomfort, its severity and its location. “Individuals who have sinus problems typically describe their discomfort as pressure and congestion. Migraine sufferers, or those with cluster headaches, will say their pain is very severe and more than just pressure,” Levine says. Levine typically does not use the word “pain” unless the sinus patient specifically mentions experiencing pain. “I want them to use pain if in fact there is pain. I look for them to use the words that are more descriptive and can help differentiate the cause. I look for them to use words like pounding or steady or vise-like,” he said.

He then asks the patients to describe the severity of the discomfort on the typical 10-point pain scale. As in real estate, location, location, location is key. Location is important in diagnosing nasal problems and other kinds of head discomfort. Levine asks patients to point to the site of their discomfort or perceived sinus pain. He says some point to their noses, cheeks or brow bones while some point to their temples or the back of their heads--places where there are no sinuses.

He says once he has a history, he may use a nasal endoscope or a computed tomographic (CT) scan to examine the nose to look for physical deformities such as a deviated septum, a blockage in the nasal passage, sinus or nasal polyps that may be the source of pain and can be corrected surgically. Also, swelling of structures in the nose known as turbinates, shelf-shaped networks of bones and blood vessels, can be responsible for sinus discomfort, says Levine. Turbinates warm, humidify and filter the air. Levine says the turbinates can cause nasal obstructions and discomfort when people have a cold or allergies and when they encounter irritants.

If true sinusitis is confirmed, current treatments include several choices of medications that may include over-the-counter nonsteroidal anti-inflammatory drugs, decongestants in pill or spray form, nasal steroid sprays and antibiotics if a bacterial infection is found. Patients should ask their physicians and pharmacists about potential side effects from the drugs.

Levine says he has had an eye out for years for a non-drug product that can help his patient with sinus pain. “If there are non-invasive or minimally invasive treatments to help my patients and give them comfort, then I am going to inform my patients about them” he says. Levine says a product such as ClearUP Sinus Pain Relief should be safe, effective and have minimal side effects.

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