When a person has three common sinusitis symptoms congestion, postnasal drip, and headache it seems logical to conclude that he or she has sinusitis. But sometimes what seems logical is still wrong. How can this be?

In some cases, a person has more than one health ailment, so a constellation of symptoms that are actually unrelated seem connected, and what seems like sinusitis isn’t really sinusitis at all.

Let’s take a look at some of the most common examples where patients and doctors may mistake other diseases for sinusitis.

Reflux

Reflux occurs when acid and other digestive juices in the stomach flow upward instead of downward. No doubt you’ve heard of the most common type, gastroesophageal reflux disease (GERD), which causes heartburn and can damage the tube connecting the throat and stomach (the esophagus) if left untreated.

There’s also a lesser known kind of reflux called laryngopharyngeal reflux (LPR), in which stomach acid continues through the esophagus and travels up to the voice box (larynx) and the back of your throat (pharynx).

LPR does not usually cause heartburn. As a result, it’s sometimes referred to as silent reflux. Instead, it tends to cause symptoms like hoarseness, constant throat clearing, and the feeling of a foreign body in the throat just below the Adam’s apple.

Because reflux brings secretions to the back of the throat, it can feel like postnasal drip, one of sinusitis’s key symptoms. But the drainage doesn’t get better with typical sinus medications, such as nasal steroid sprays, antihistamines, and mucus-thinning agents.

An ENT specialist can diagnose reflux if an exam shows inflammation of the back wall of the larynx and pharynx. To confirm the diagnosis, your doctor may want to look directly into the esophagus with a flexible endoscope or measure the acidity (pH) of liquids in the esophagus with a probe.

Treatment for GERD and LPR starts with lifestyle and dietary changes. These simple antireflux precautions can lead to dramatic improvement:

• Avoid foods that cause reflux, such as alcohol and caffeine.
• Do not eat before bedtime so less acid is secreted while you sleep.
• Elevate the head of the bed so your head is above your stomach during the night. (You can best do this by putting wooden blocks under the legs at the head of the bed or by sleeping with your upper body on a solid foam wedge.)

Taking an antacid like Mylanta or Maalox one hour after meals and before bedtime can complement these measures. If symptoms persist, acid-reducing medications are available over the counter or by prescription.

There are two basic types: H2-blockers (including Pepcid, Tagamet, and Zantac) and proton pump inhibitors (such as Nexium, Prilosec, and Protonix). One final gastrointestinal note.

Some physicians believe there is, in fact, a strong connection between reflux and sinusitis. They have proposed that most cases of sinusitis are caused by acid and other gastric contents flowing all the way up to the nose and sinuses at night, but this theory remains untested.

Dental Disease and TMJ

Certain dental disorders can mimic sinusitis. A common example is an infection of the root of a tooth in the upper jaw. Because the roots of these teeth are adjacent to the floor of the maxillary sinus, such infections can cause pain that radiates to the cheek and closely resembles sinusitis.

Inflammation of the jaw joint, called the temporomandibular joint, or TMJ, can also cause facial pain that mimics sinusitis. You can feel the TMJ move by putting a finger just in front of your ear and opening and closing your mouth.

Soreness or clicking in this region may indicate an abnormality. TMJ pain can result from a variety of causes, including unconsciously grinding your teeth while sleeping and arthritis of the jaw joint.

Whatever the cause, initial treatment involves a soft diet (no apples or steaks), warm compresses over the joint, and an antiinflammatory medication (like Advil or Motrin).

If that doesn’t work, a dentist can fashion a plastic mouth guard that resembles a retainer commonly used by teenagers who have had braces.

This device, which is worn at night to take pressure off the TMJ, is highly successful at relieving the associated discomfort. In the most extreme cases, an oral surgeon can operate on the TMJ to smooth irregularities of cartilage and bone within the joint.

Interestingly, the confusion between dental and sinus problems goes both ways. It’s not uncommon for a maxillary sinus infection to be mistaken for a dental problem, because pain in this sinus can radiate to the upper teeth.

When this happens, a dentist may pull a healthy tooth and even perform an unnecessary root canal. A dental x-ray or sinus CT scan can usually determine which is the true source of the pain.

Migraines

Migraines are a common cause of headaches, occurring in about 10 percent of the population. They usually cause a severe, throbbing pain, most often on one side of the head. A migraine headache can last hours or even days and can be associated with nausea and light sensitivity.

Some people know when a migraine is about to start because they experience vision changes (known as an aura), commonly dark patterns or wavy lines in the corner of their eyes.

Migraines used to be referred to as vascular headaches because they were thought to result from abnormal dilation of blood vessels. However, recent research has not supported this theory, and their actual cause remains unknown.

A migraine can be confused with sinusitis because nasal discharge often accompanies the headache. However, unlike sinusitis, the drainage from a migraine is usually clear and one-sided.

Also, the pain from migraines is more likely to be located on the side of the head, whereas sinus headaches tend to occur in the forehead region or the back of the head. In addition, migraines are likely to affect only one side of the head, whereas sinus headaches usually occur on both sides.

A variant known as facial migraine can be mistaken for maxillary sinusitis because it causes pain in the cheeks and/or forehead. This entity is a real possibility when patients have facial pain but their sinus CT scans are clear.

Migraines can sometimes be prevented by identifying and avoiding what triggers an episode, such as caffeine, alcohol, certain foods, and stress. If this approach does not work, over-the-counter migraine medications may help, as well as prescription drugs available through your primary care physician or neurologist.

Although sinusitis and migraines are two separate entities, for some people the two ailments appear to be related. It’s not uncommon for sinus infections to trigger migraine headaches. In these cases, getting better control of sinusitis often leads to a reduction in the frequency of migraines.

Neuritis

Neuritis refers to inflammation of nerve endings that can trigger pain anywhere in the body. When the pain involves nerves in the face or head, it can be mistaken for a symptom of sinusitis. There are many causes of neuritis, including viral infection, diabetes, immune disorders, and trauma.

Neuritis affecting nerves in the nose can sometimes occur after sinus surgery. A common treatment for neuritis is antiseizure medications (such as Neurontin) that were developed to treat people with epilepsy.

Because the pain from neuritis is chronic, medications containing narcotics are best avoided, to prevent the possibility of addiction. Injections into the specific area of facial pain with anesthetics, steroids, and Botox have also proved successful.

Neuralgia

Neuralgia literally means “nerve pain.” Like neuritis, it has many different causes and can be confused with sinusitis when it affects the face or head. Trigeminal neuralgia a condition affecting the trigeminal nerve, which supplies sensation to much of the face is the most common type of neuralgia in this region.

It usually involves intermittent episodes of brief, sharp, intense pain affecting one side of the face. One popular theory attributes trigeminal neuralgia to an abnormally shaped blood vessel pressing against the nerve.

Like neuritis, it can be treated with medications and injections, but surgery to identify and move the abnormal blood vessel from the trigeminal nerve has also been successful in many people with this disorder.

Atypical Facial Pain

When physicians are unable to determine the specific source of a person’s facial pain, they may make a diagnosis of atypical facial pain. In other words, we just don’t understand the cause.

For patients with persistent facial pain that has not responded to standard therapy, a multidisciplinary pain clinic is often the best option.

These clinics, which draw on the combined expertise of specialists (such as anesthesiologists, neurologists, ENT doctors, physical therapists, and psychologists) are becoming more commonplace in large hospitals and referral centers.

They offer the latest in diagnostic and treatment techniques for patients suffering from bodily pain. What does the future hold for sinusitis treatment?

We’ll look at what’s on the future of sinusitis medication.