Our previous two blogs on Pain Management had covered key aspects of facial pain in relation to neurology and dentistry . In this blog, which is part three of our Pain Management series, we cover ENT – and its factors that contribute to facial pain.
Ears
With all twelve cranial nerves innervating the face, ear, nose, throat, head and neck, the pain perceived by the individual may be related to each other. The manifestations of pain may be from a superficial structural origin to a deep seated one. Take the example of hair root follicle of nose or ear, it causes swelling and excruciating unbearable pain. Wax in the ears, if it swells causes occlusion of the ear canal exhibiting pain. Infection of the upper respiratory track causes block in the nose leading to absorption of air in the tympanic membrane. This generally happens during sleep and patients wakes up with excruciating pain early in the morning. The culprit’s origin here is the nose and not the ear. Water entry into ears will cause growth of fungus in the ear, with presence of wax, providing a wet and humid treatment. Otomycosis as the condition is called will cause pain in the ears.
Nose and Throat
Everybody is familiar with pain in root of nose which is pulling type in nature. This is generally due to sinusitis. Any obstruction to flow of mucous inside nose results in sinusitis causing headache and facial pain. Infections and inflammatory conditions of nose make the patient uncomfortable with pain and reduce the concentration at work. Throat pain due to cold, pharyngitis will be accompanied by difficulty in swallowing.
Tonsillitis and infection of surrounding tissues results in painful swallowing and increased secretion in the oral cavity. Deep seated pain over the sides of the neck can be due to enlarged styloid process which is a bone protruding from the skull. This will be identified by scans and removed will help in early resolution of problem.
Ulcers of oral cavity and throat are common in nutritional deficiencies or recovery phase of illness. A tooth pain can be perceived as ear pain due to the same nerve supply. When there is any swelling in the neck, pain in ears, difficulty in swallowing or breathing, with change in voice, this could be a pointer for cancerous lesions.
Treatment
Most of the pain can be treated by painkillers, local anaesthetic drugs, steam inhalation, gargles when the pain is superficial.
Intractable pain, pain which does not respond to maximum treatment, needs careful evaluation of history and should be further investigated.
