FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER'S SINUS PROBLEM MAY ACTUALLY BE VASOMOTOR RHINITIS

Question: I am suffering from a syndrome that I cannot find much information about. The symptoms are as follows: when the outside temperature drops below freezing, I develop head sinus pain that lasts for three to four days. Subsequently I get a continuous discharge, from primarily my left nostril. These headaches are extreme and even cause loss of balance. After a few days the cycle begins again, and this continues through January and February. My doctor suggests that I might be allergic to something in my home. If that were the case, why would I not have it at warmer temperatures?

Answer: Because the tissues of the nose and sinus areas have abundant nerve endings, any condition that causes swelling or irritation in the nose and sinuses can also produce pain. True sinusitis - an actual infection in the sinus cavities - is over diagnosed by individuals who think they have sinus problems as well as by their physicians.

The symptoms you describe - pressure and pain in the face - certainly can be the result of a sinus infection, but blockage of the sinus openings is a more common cause. There are several different possible causes of this type of blockage, including allergy-induced nasal swelling, the common cold, tumors and cysts. Also, a condition called "vasomotor rhinitis" produces nasal swelling without any allergic component. This is what I think you may have.

The bones and cartilage that make up your nasal passages and sinuses are covered with nerve-rich mucus membranes. Beneath some sections of the mucus membrane there is a special tissue that can engorge with blood, thereby causing that common experience of having one's nose suddenly become "stopped up." Functioning of this complex system is under the control of the nervous system. Therefore, any conditions that interfere with the nerves, blood supply, mucus membranes or the bones themselves can produce "sinusitis" symptoms.

Also contributing to "sinus problems" is the fact that nasal and sinus bones can be shaped in ways that are not optimal and, thereby, increase the risk of sinus infection or cause pain in other ways. These problems can include sinus openings that are too small or too large as well as irregularly shaped nasal bones that reduce space for air passages. While it can be difficult to determine the exact cause of nasal swelling, discharge and pain, your history helps narrow the possibilities. You are correct in your assumption that allergy would cause your symptoms at other times. An additional clue comes from cold temperatures bringing about an attack. Infection doesn't work this way, but my prime suspect - vasomotor rhinitis - can be triggered by cold exposure.

Vasomotor rhinitis is an incompletely understood disorder that involves a disturbance in the way the parasympathetic nervous system controls the blood vessels in the nose. An attack produces swelling in the nose with resultant "sinus" pressure and pain. The glands of the nose become overactive. This produces the runny nose. In addition to cold exposure, attacks can be triggered by polluted air or even bright light exposure.

There are effective treatments for vasomotor rhinitis, but there is currently no cure. Many family doctors are skillful at treating this disorder. If your family doctor isn't well versed in treating it, however, he or she can refer you to an ear-nose-throat specialist who can help you.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.