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Introduction: Allergic fungal sinusitis (AFS) is a relatively uncommon cause of sinus pain and congestion. Extreme cases may require specialty evaluation and surgical treatment.Case Report: In this case, an otherwise healthy young man presented to the emergency department with sinus pain and congestion for two weeks and was admitted to surgery for resection of his AFS.Conclusion: This case demonstrates how a thorough history and physical exam can help catch potentially serious diseases, such as allergic fungal sinusitis, from the frequently benign chief complaint of sinus pain.

Abstract Background Inflammation and swelling of the sinus and nasal mucosa are commonly caused by viral infection, bacterial infection, or exposure to allergens and irritants. Sinonasal inflammation can cause symptoms of nasal congestion, facial pressure, and rhinogenic facial pain or “sinus pain”. A previous randomized controlled study demonstrated that acute treatment with non-invasive periorbital microcurrent stimulation resulted in a rapid and clinically meaningful reduction in self-report of sinus pain that significantly outperformed sham control treatment. Here, we assessed the acute durability of microcurrent pain relief and longitudinal effects of 4 weeks of daily microcurrent treatment in patients presenting with sinus pain. Methods Thirty subjects with moderate facial pain (numeric rating scale ≥5) attributed to self-reported sinonasal disease were enrolled in a single-arm, prospective interventional study. At enrollment, subjects were given a microcurrent treatment device and written instructions and self-administered the device to the bilateral periorbital regions for 5 mins. Subjects were instructed to treat themselves at home once daily and up to four times daily as needed for 4 weeks. Pain was measured both acutely and weekly during the 4 weeks of treatment using the numeric rating scale. Congestion and medication use data were collected weekly using the Congestion Quantifier 7 (CQ7) and medication diary, respectively. Results Thirty patients were enrolled and completed the study. Microcurrent therapy rapidly reduced post-treatment numeric rating scale for pain by − 1.2 at 10 mins (p = 0.0076), − 1.6 at 1 hr (p = 0.0007), − 1.9 at 2 hrs (p

Background: Transcutaneous electrical nerve stimulation has proven to be effective in alleviating chronic pain from facial myalgias. We evaluated the efficacy of a novel handheld microcurrent‐emitting device in short‐term, office‐based treatment of patients with sinus pain. This device, which is U.S. Food and Drug Administration (FDA)‐cleared, detects and treats regions corresponding to nerve fibers. Methods: Randomized, double‐blinded, placebo‐controlled trial. Seventy‐one participants with facial pain attributed to self‐reported nasal/sinus disease were recruited from a tertiary rhinologic practice and the surrounding community and randomly assigned to either office‐based use of an active (n = 38) or placebo (n = 33) microcurrent emitter. The study device was repetitively applied by each patient to the bilateral periorbital areas for 5 minutes. A visual analogue scale (VAS) for pain severity was administered before, and 10 minutes after, treatment. Results: Active microcurrent‐treated patients had a reduction in mean pain score from 5.63 pretreatment to 3.97 posttreatment (mean difference, 1.66; 95% confidence interval [CI], 1.20 to 2.12). Patients using the sham device also reported sinus pain reductions (mean difference, 0.91; 95% CI, 0.61 to 1.21). However, the active device demonstrated a significantly greater reduction in pain compared to sham (0.75‐point difference, p = 0.007). Notably, 23.7% of patients using the active device had a reduction of 3 or more points by VAS compared to 0% of sham device patients (p = 0.003). One minor occurrence of transient facial skin erythema was noted. Conclusion: This trial suggests that treatment of rhinologic facial pain using this noninvasive microcurrent device is safe and effective in providing rapid relief of nasal/sinus pain. Additional studies with longer term follow‐up are warranted. [ABSTRACT FROM AUTHOR]

Abstract Introduction The absence of opacities on CT scan usually eliminates paranasal sinus disease as a cause of facial pain. The authors report a case, which constitutes an exception to this general rule, corresponding to a new aetiology of sinus pain. Case report A 16-year-old boy presented with very painful "recurrent acute sinusitis" triggered by pressure changes (altitude, diving, surfing), with no sinus opacity on CT scan. Surgical exploration demonstrated absence of a primary or accessory maxillary ostium. Middle meatus antrostomy relieved the patient's pain. Discussion The pathophysiology of this case of recurrent acute pseudo-sinusitis and the efficacy of antrostomy can be explained by the evo-devo theory of the origin and function of the paranasal sinuses. This case illustrates the absence of communication in the ethmoid of the membranous sac lining the maxillary sinus, formed by degeneration of the maxillary erythropoietic bone marrow. Under stable environmental conditions, the continuous production of nitric oxide by the sinus epithelium is eliminated by simple transmembrane diffusion, but is insufficiently eliminated in the case of rapid pressure changes, inducing sometimes very severe sinus pain, mimicking sinusitis. This case report paves the way for more detailed studies on the role of the paranasal sinuses in facial disease and respiratory physiology. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To study differential diagnosis and efficacy of management strategies in patients presenting to an otolaryngologist for sinus pressure, pain, or headache. Study Design Retrospective analysis at an academic medical center. Methods Patients were seen in the clinic (2010-2012) for sinus-related headache, pressure, pain or fullness (study symptoms) by a rhinologist. A retrospective chart review of patients with study symptoms was conducted. Results Of 211 patients with study symptoms, 70.62% met American Academy of Otolaryngology-Head and Neck Surgery criteria for sinusitis or had rhinologic disease. Otolaryngic therapy alone (medical or surgical) relieved study symptoms in 51.66%; combined neurology intervention helped another 15.17%. Nearly half of the patients (48.82%) were diagnosed with primary headache disorders. Comorbid rhinologic-neurologic disease was present in 27.96% and odontogenic disease in 7%. Initial otolaryngology referral was likely unnecessary for 36.49% of the study patients. Sinus computed tomography (CT) was available for 91% of 211 patients, and 80% of scans were positive. Endoscopic sinus surgery (ESS) was used in only 80/211 patients (37.69%) and was effective in 66/211 (31.28%). ESS was most successful in patients receiving concurrent neurological intervention. The Lund-Mackay CT score did not predict outcomes from ESS. Interdisciplinary otolaryngology-neurology efforts resulted in a positive outcome for 92.4% of patients. Conclusions We present the first series detailing management of patients with sinus-headache pain in an otolaryngology practice. Such symptoms have multifactorial etiologies. Positive sinus CT results require cautious interpretation. ESS should be judiciously used. Interdisciplinary care is critical for success: approximately 50% of patients benefited from otolaryngic management, 50% needed neurological treatment, and 7% required dental disease management. Level of Evidence 4 Laryngoscope, 125:303-310, 2015 [ABSTRACT FROM AUTHOR]

The interplay between head pain caused by sinus disease and primary headaches is complex. Classification of secondary headaches, attributed to disorders of the nose or paranasal sinuses has been recently updated. New treatments including office- based procedures are emerging for patients with chronic sinusitis. This paper briefly reviews sinus disease and headache. [ABSTRACT FROM AUTHOR]

Headaches of rhinogenic origin illustrate an interesting paradox. Little is known about their pathophysiology, mechanisms, and prevalence; yet, the concept that these headaches are of importance is widely accepted. This article discusses the relationship between fronto-turbinalis sinus expansion and headaches, as well as headache outcomes after surgical approach. [ABSTRACT FROM AUTHOR]