Nose cartilage pain, no redness or swelling

Hi guys, I think i'm in something of a similar situation here.

In June 2019 I began feeling pain in my nose what I assumed was Sinus pain. I didn't do much until a month later in July when I went to an urgent care and they said "yeah probably sinus infection" and I got what I think was a round of antibiotics and probably a steroid. That didn't end up doing anything, and the pain got steadily worse. I did basically the same thing a month later with a different urgent care, and in Sept i finally went to an ENT. They looked at it and said "doesn't look like much, take a Zyrtec, flush with this saline solution, use some sprays, etc". I did that for a few weeks with no results. I also got a Vicks steam making thing and religiously steamed my sinuses. While that was better than nothing, it had no lasting impact, leading me to believe that it wasn't related to dryness.

After another visit with that ENT, I visited the Ohio Sinus Institute in Dublin, OH. They seemed to be a reputable place to go for what I was experiencing. The Dr. Boris Karanfilov immediately did a CT scan and walked me through it showing me that i didn't have any congested passages, etc. Nothing visible that he noticed. He then ordered an MRI which I did and that also didn't show anything.

I also went to an allergist who ruled out any obvious allergies that could be causing my pain. My PCP suggested I ask for a scope, but the Sinus doc said there would be no point as he has already seen enough from the CT scan and MRI (So I haven't had a scope yet). The Sinus doc suggested going to a Neurologist, but I haven't at this point yet either.

My primary symptoms are pain on what feels like more of the outside of the bridge of my nose than anything. I have no real congestion, no drip, no redness or swelling, just pain that feels like almost a sunburn at times, sometimes tingly, and if anything i'd say its coming from the cartilege itself, not my "sinuses" internally. It is not 100% constant, and I even had a few weeks in January where I thought it might have gone away. My wife thinks that it is sort of created by my brain - Mind Body syndrome, Dr. Cerner, that kind of thing. Maybe stress related, etc?

Here's a few other things I am suspicious of that i'd like to get ruled out:

nasal Sarcoidosis
Relapsing Polychondritis
Multiple sclerosis
Nasal furunculosis
nasl staph infection.

I'd love to hear anyone elses thoughts about what I might have and what I should ask my doctors to look at. I'm not above going to the Mayo clinic, but as I'm in Ohio, Cleveland Clinic might happen first 😉

Thanks!

Hi John, I have had very similar symptoms to you and have been diagnosed with mid segment facial pain. I was diagnosed years ago with non allergic rhinitis and also have a deviated septum. I have managed this quite well myself with occasional guaifenesin to thin the post nasal mucous and Beconase spray for the nasal passages. In addition I have been prone to Eustachian tube dysfunction but not to sinus infections. In October of last year my most started to feel "strange". as if it was swollen and a little tingly. I also had uncomfortable pressure over the bridge of my nose. This varied in intensity. After having seen three general practitioners and told I had sinusitis, I recently saw an ENT specialist who told me I have mid segment facial pain, a poorly understood syndrome believed to be caused by neuropathic pain. The pain receptors go on overdrive. So your wife is perhaps somewhat correct. This is "tricky" to treat apparently but responds well to low dose amitriptilline. This is one of the older drugs that in higher doses was used as an antidepressant before SSRIs became available. The specialist told me to manage the problem with over the counter pain killers unless my quality of life was being affected, in which case to try amitriptilline. He also prescribed Dymista nasal spray. He ordered a Cat Scan, to rule out sinusitis, but expects it to be normal. It has really helped me to have an idea of what is going on. The symptoms have improved somewhat. My nose starts out feeling "inflamed" but tends to improve during the day. I am keeping the amitriptilline as a next step if needed. Since it is a pain (more like ache) syndrome, I am also using meditation type "stuff" and I believe it helps Hope this helps you in your quest for answers. I know there are worse problems than these ENT issues but they can certainly make life miserable for us and the people around us!

Hi there ! I have the same exact thing going on rightnow and I’m really worried . Did you ever go see a neurologist? Or did you find out what you had ? Thank you !

thanks @nrd1, I appreciate the comments!

An update as to where I am - have seen a few Neurologists, the current theory is that there is something going on with my Sphenopalatine Ganglion. For now I am taking Nortriptyline which did work very well for about a month, starting to become less effective. Might have a block at some point in the near future as well.

Hi @nicleelee. I know it has been a while since your last post, but I was wondering if you found a solution to your problem? I have the same symptoms as you. When I touch or scrunch my nose, pain radiates to my left temple. I have no other symptoms, and Advil/Tylenol doesn’t seem to work for me.

@john02445, Have you found anything out on your pain? I am experiencing something similar in my right nostril with no change after antibiotics, and no fever, swelling or redness. When touched, the pain can radiate to right temple and the corners of my right eye like a pressure. After a CT scan, only what seemed to be a minimal to no infection at the bottom of my front right and left sinuses which my ENT believed should not cause that type of pain. I almost feel like it is IN my cartilage as when I pinch are from outside and inside the nostril, the pain isolates there. Anything new would be helpful!

Hi , did you ever get a diagnosis or did this go away ? I have the same thing ! Thanks !

I have had the same thing, but mind is a bit higher on the bone. It started two days ago. Feels like I got hit in the nose with something. Absolutely no visible signs of anything. Hurts the most on the right side of the bridge of my nose. Kills if I touch it and radiates up into my eye and temple. I also am thinking some type of sinus infection. Ibuprofen seems to help. If It doesn't let up soon, I guess I will call my PCP.