My brother has been having problems with facial pain, seemingly liked to his nose and sinuses, which has been going on for about 4 years now.

He had plastic surgery on his nose to correct a raised bump in his nose around 10 years ago. We don’t know whether this had anything to do with the pain he has been having but there was quite a bit of time in-between the surgery and the pain starting.

Its limited to the right-hand side of the face and the pain seems to be centred almost behind the tear duct, if not slightly below and towards the nose.

He has had several treatments over the last few years including grommets, nasal surgery, turbinectomy etc. but the pain is still there.

The pain is intermittent although he constantly has a tight sensation in his face/nose and squirts water up his nostril (right only) which he then blows out to help clear the feeling - this mainly drains through the left nostril though. He can go a few days without pains and then some days get 2 or 3 in a night, some resulting in him being sick from the pain.

He has found that keeping cool minimizes the amount of pains he gets but does mean he is sat in front of an industrial fan most of the day and all night – this is obviously preventing him from working or getting proper sleep. The thought behind being cool is that the pain is a result of swelling in the nasal cavity/sinuses that presses against a nerve or something and keeping cool means the swelling doesn’t happen. He can take Sumatriptan tablets, which help reduce blood vessels, and these seem to work but he's limited to 8 a month.

The feeling he has is that there is a blockage or the nasal valve in the right nostril has collapsed or malfunctioned. He can’t breathe properly out of this side therefore mucus builds up in the sinus and has nowhere to go. He recently had a swab on the mucus build up in his nose, which showed an infection. This has since cleared but he still gets the pains - all suggesting a blockage/ventilation being the problem. When he blows his nose, his right ear squeaks suggesting the air is forced out his ear rather than his nose.

His most recent surgery was in February/March. This included a second turbinectomy, widening the nasal opening, clearing the sinuses and a balloon sinuplasty. Initially the onset of the pains subsided and he went nearly 4 weeks without a pain, although the tight feeling remained and he had to stay cool to keep them at bay. They have since returned to how they were, suggesting either the surgery didn’t work, some of the work carried out has since 'failed' or the build-up of mucus has begun again.

What my brother has suggested is that he wants the mucus build up cleared, the valve within the right side of his nostril/sinus 'fixed' to allow him to breathe out properly along with any other possible blockage in the ear cleared. This he feels will hopefully stopping the mucus build up and pressure that we believe is leading to the pains.

Anything anyone can suggest in terms of initial diagnosis of the symptoms, thoughts from people who have experienced similar things, what treatments are potentially available etc. would be a great help.