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Chronic inflammation in maxillary sinus. Allergic to pets and dust. What treatment should be done?

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ENT Specialist
Practicing since : 1991
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Hi,
I'm in the process of having back teeth implants.I've already had 8 back teeth extractions.Last XXXXXXX I had a CT scan & according to my dentist I have chronic inflammation in the Upper Left/Right region maxillary sinus & accordingly implantation cannot proceed until it is taken care of.

My GP prescribed me 'Beconase' spray which I used it.On the insistence of my dentist I saw an ENT specialist who after checking me & seeing the CT scan wrote:'I do note a dependent fluid level in the left maxillary antrum,but otherwise the rest of the visible paranasal sinuses were clear.Often such findings of inflammation are incidental & require no active ENT treatment'. He prescribed me 'Nasonex' spray which I used it.

Last week I had another CT scan & unfortunately there has been no change at all.My dentist feels that a FESS operation is required on the right sinus which I'm not keen at all as I do not suffer from headaches,blockages, or any of the other symptoms.My dentist showed my CT scan to an ENT specialist colleague whose opinion is:
'I checked the CT scan. The CT shows discrete thickening of the mucosa in the alveolar area of the sinus, I do not think it affects the performance of the augmentation. There is a significant mucosal swelling on the left side, there is hardly any air content, we should perform a functional endoscopic sinus surgery (FESS) before the augmentation, possibly together with a nasal septum spina removal, which is blocking the front area of the middle nasal passage. I would expect spontaneous improvement after several months of nasal spray treatment (that probably contains steroids).'
As said above I do not suffer from any of the sinusitis symptoms although I've been allergic to pets,dust & rarely pollen.
I would appreciate your advice.

Best regards,
XXXXXXX
Posted Sun, 7 Oct 2012 in Ear, Nose and Throat Problems
Follow-up: Chronic inflammation in maxillary sinus. Allergic to pets and dust. What treatment should be done? 54 minutes later
Hi Dr.,
I just want to add the following:
- I've had 11 back teeth extractions & I'll be having 8 teeth implants.
- I've had several root canal infections in the past.
- The ENT specialist prescribed as well NeilMed sinus rinse which I'm using twice daily.

I would like to repeat that I do not suffer from any of the sinusitis symptoms be it headaches,nasal discharge,nasal blockage,facial pain or pressure.

Regards, XXXXXXX
 
 
Answered by Dr. Sumit Bhatti 3 hours later
Hi,

Thank you for your query.

1. Is it possible for you to share the images (not the report) of your CT PNS (Para Nasal Sinuses)? It will help in giving you an accurate assessment. The scan should be on a new generation multi-slice scanner with 1 mm coronal, axial and sagittal cuts.

2. Blocked sinuses are poorly ventilated and along with stasis of secretions, continuing sub-clinical infection and inflammation is common, leading to mucosal thickening. Sometimes, the infection is fungal and hence medication does not help. Fluid levels are signs of acute exacerbations of the disease. Hence supportive treatment is required. Local decongestant drops may be used to reduce the blockage.

3. Sometimes there is a 'biofilm' formation which causes chronic sinusitis. A nasal swab or any discharge may be sampled for culture and antibiotic sensitivity. A look at the images of your plain CT PNS (Para Nasal Sinuses) will definitely help understand your problem.

4. Chronic sinusitis should receive a trial of medication initially. You may require a further course of anti-allergics, anti-leukotrienes, decongestants, mucolytics and steam inhalation. This should be done under medical supervision. I would recommend a newer generation steroid nasal spray besides Beconase (beclomethasone), such as Nasonex (mometasone), fluticasone or ciclesonide which have far fewer absorption and side effects. Your allergy to pets (avoidable), dust and rare pollen allergy (unavoidable) will easily be controlled by medication.

5. I have always observed that many times isolated maxillary disease is due to dental disease, often with aggressive root canals and previous oro-antral fistulas. It is difficult to justify a septoplasty at the age of 59 years. Balloon Sinuplasty may be an option. Radio-frequency and Co-ablation assisted surgery are also newer options as compared to FESS (Functional Endoscopic Sinus Surgery).

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Chronic inflammation in maxillary sinus. Allergic to pets and dust. What treatment should be done? 24 minutes later
Hi,

Thank you for your reply.
1. I have the internet link of the CT scan which is:

WWW.WWWW.WW
2. As said before I have no sinus blockages whatsoever,nor secretions.

Kindly advise.
Regards, XXXXXX
 
 
Answered by Dr. Sumit Bhatti 6 hours later
Hi,

Thank you for writing back.

1. There is definitely Maxillary sinusitis, Left > Right. Other visualized sinuses are clear. There is a posterior bony deviation to the left with a bony spur (images 83 to 112).

2. I have not been able to reformat the images into coronal views, however there seems to be an osteo-meatal block worse on the left. The opening seen in the left middle meatus seems to be an accessory Maxillary Ostium since it is visible in vertical plane posteriorly in the middle meatus (images 58 to 65). Such accessory ostia explain the air in the sinus but are not efficient in helping sinus secretion drainage which goes through the main ostium. The ciliary mucosa beats only towards the natural main ostium. This causes stasis of secretions (fluid level) and mucosal thickening.

3. There is a small un-infected concha bullosa (Air Cell) in the middle turbinate on the right side with bilateral lamellar cells of Grunwald. Right middle turbinate appears paradoxical in the middle one third. These do not require treatment. You may avoid a Septoplasty. For the bony spur an limited endoscopic excision may be done. Expecting the left maxillary sinus to recover completely is highly unlikely on medication alone, though theoretically possible. If it interferes with your dental implants, you may safely go ahead with extremely limited FESS (Mini-FESS). As I have mentioned before, any dental related mucosal inflammation will also reduce once the ventilation of the maxillary sinuses improves.

4. You will definitely benefit from a Mini-FESS. Opening the maxillary sinuses is a relatively simple, quick and safe procedure in endoscopic surgery. If you are apprehensive about general anesthesia, both the maxillary sinuses can be opened under local anesthesia. Balloon Sinuplasty is also a good option.

Wishing you an uneventful surgery and a speedy recovery.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Chronic inflammation in maxillary sinus. Allergic to pets and dust. What treatment should be done? 5 days later
Hi Dr.,
Thank you for your very clear answer.
Could you inform me in return if you do this mini-FESS operation, or if you could put me in touch with an ENT specialist who does operate,the location of the hospital/clinic-I prefer the London area where I live-, the costs as well please?
I have to fund it privately as the NHS waiting period is 3-4 months & I would like to get over this issue soonest possible so that I can continue with my dental implantation.
I would appreciate your quick reply,
Regards, XXXXXXX
 
 
Answered by Dr. Sumit Bhatti 7 hours later
Hi,

Thank you for writing back.

1. I am based in Pune City, Maharashtra State, India.

2. You may consult Dr. Anirvan Banerjee for guidance. He is an ENT Consultant with XXXXXXX Cook University Hospital, South Tees Hospitals NHS Trust, Middlesbrough +44 7968 0000.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
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