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Chronic sinusitis. Scan report shows slight deviation of nasal septum and polypoid degeneration. Suggestions?

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Hello, I recently had some imaging done on the paranasal sinuses with coronal reformatted images, and have occasional chronic sinusitis. Are the following of any real concern, or do they just sound scary?
Slight deviation of right of anterior nasal septurm and focal pneumatization of perpend. plate of ethmoid.
Nodularity suggesting polypoid degeneration , ventral displacement of anterior most post portion of left nasal bone and deformity of nasal bones (deviated septum?). Also, two adjacent large Haller cells 1.3 cm and 0.6 cm each on right, smooth contoured lobular opacity, possible cyst versus nonobstruct. polyp. Elongation of left lobe in axial plane compatible with axial myopia.
Posted Wed, 18 Apr 2012 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Naveen Kumar 2 hours later
Hi

Thanks for the query

First of all let me assure you that, the report does not mention about any serious problems.

To discuss with you in detail regarding this report:
1. Slight deviation of right of anterior nasal septum - is a normal anatomical deformity seen in most individuals, but only a few will have nasal block with this amount of deviation.

2. Focal pneumatization of perpend. plate of ethmoid - this explains about an air cell trapped inside the rear part of the bony nasal septum. Again, this is more of a surgical significance than a problem.

3. Nodularity suggesting polypoid degeneration - this description is not very clear as it does not mention where exactly the polypoid degeneration is present.

4. Ventral displacement of anterior most post portion of left nasal bone and deformity of nasal bones (deviated septum?) - this is not of much significance, as it describes about the external nasal deformity and this is nothing to do with your problem.

5. Also, two adjacent large Haller cells 1.3 cm and 0.6 cm each - these are the air pockets in the infra-orbital part, i.e. in the base of the orbit (socket of the eye) and this is more of surgical relevance.

6. On right, smooth contoured lobular opacity, possible cyst versus nonobstruct. polyp - this is a solitary polypoidal lesion or a retention fluid filled sac present in the maxillary sinus. This is something which is noticed in allergic conditions of the nose. As it is not obstructing the maxillary sinus opening, this is very unlikely to cause blockage of the sinus secretions. The advantages of removal of this cyst have to be weighed with the severity of the symptoms.

7. Elongation of left lobe in axial plane compatible with axial myopia - indicates the refractive error of the eye.

To sum it up, there are no significant problems noticed in the report furnished by you. Your problems need to assessed and compared with that of the findings of the CTscan after which a decision has to be taken whether you require surgery to remove the solitary cyst in the right maxillary sinus.

Hope I have answered your query; I will be available for the follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
Follow-up: Chronic sinusitis. Scan report shows slight deviation of nasal septum and polypoid degeneration. Suggestions? 4 hours later
Many thanks. Now regarding the nodularity, it says more specifically, "There is nodularity of the contour of the nasal turbinates suggesting polypoid degeneration." Does this provide more information for you?
Regarding the fluid cyst, is this regarding the "retention cyst versus nonobstructing polyp, or "cyst formation" arising from the alveolar recess on the right"?
And would any of the issues have a relationship to regular or chronic tearing from the right eye?
Thank you.
Follow-up: Chronic sinusitis. Scan report shows slight deviation of nasal septum and polypoid degeneration. Suggestions? 13 minutes later
Would these issues be the cause of sinus infection with light yellow discharge requiring antibiotics at least twice a year, and is this repeated event involving antibiotics twice a year a potential problem in and of itself?
 
 
Answered by Dr. Naveen Kumar 9 hours later
Hello.

Thanks for writing back.

1. There is nodularity of the contour of the nasal turbinates suggesting polypoid degeneration - This is usually seen in allergic conditions of the nose wherein the mucosa of the turbinates becomes rough with multiple bumps, more precisely known as Mulberry turbinates. This is a typical feature of Chronic Allergic Rhinitis wherein, the lymphoid follicles get enlarged making the mucosa appear rough just like that of the surface of the mulberry fruit.

2. Is this regarding the "retention cyst versus nonobstructing polyp, or "cyst formation" arising from the alveolar recess on the right"? - I presume it to be more of a polyp than a retention cyst, because if the cyst is arising from the alveolar margin, then there will be a breech in the bony surface of the floor of the maxillary sinus which is usually picked up in the CT scan. According to the description mentioned in your query, it is the polypoidal mass in the Haller cell itself which is not obstructing the maxillary sinus opening.

3. Would any of the issues have a relationship to regular or chronic tearing from the right eye? - Your CT scan report does not mention about any mass impinging over the nasolacrimal duct or any bony obstruction. There could be two things which could be the cause of this lacrimation either allergic rhinitis or nasolacrimal duct obstruction (which has to be confirmed by lacrimal syringing).

4. Would these issues be the cause of sinus infection with light yellow discharge requiring antibiotics at least twice a year, and is this repeated event involving antibiotics twice a year a potential problem in and of itself? - Recurrent Sinusitis could be due to nasal allergy followed by inflammation of the sinuses and infection.

There are few things which need to be understood:
a). Haller cells if they are big enough, they can impinge over the infundibulum (opening) of the maxillary sinus leading to recurrent sinusitis and headache, as there is no mention about blockage of the infundibulum it is very unlikely to be the cause of recurrent sinusitis.
b). Finally, the attacks of sinusitis once or twice in a year is very common. But, if the symptoms are severe and not responding to the medicines then you would get some benefit from the surgery.
c). Also, I would like to suggest you to drink plenty of warm water, do steam inhalation 3-4 times/day, use saline nasal drops to regularize the mucociliary movements and clearance of the mucus.

Hope, this answers your query. Wish you good health.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
Follow-up: Chronic sinusitis. Scan report shows slight deviation of nasal septum and polypoid degeneration. Suggestions? 1 hour later
Thank you very much. To clarify about the cyst, the report says specifically:
"Smooth contoured lobular opacity likely a retention cyst versus nonobstructing polyp arises from the right alveolar recess."
Ironically, when the doctor spoke to me over the phone he said there "is no cyst." Of course I want to go back and clarify, but is he intepreting the above information differently?
Follow-up: Chronic sinusitis. Scan report shows slight deviation of nasal septum and polypoid degeneration. Suggestions? 17 minutes later
With regard to the degeneration of the turbinates, is there any way to normalize the roughness of the mucosa through any treatment? And if not, could it subsequent negative health implications? Thank you.
 
 
Answered by Dr. Naveen Kumar 10 hours later
Hi again,

Thank you for writing back.

If the report mentions that the lesion is arising from the alveolar recess, then it could be more of a retention cyst rather than a polyp. Retention cyst is a fluid filled sac with a well defined and thickened margins, which is not seen in the case of a polyp.

Secondly, the degeneration of the polypoidal mucosa cannot be corrected. And also, it is quite harmless and not going to cause any negative health problems.

If you can mail me photos of the CT scan done, I will be able to help you better and suggest you regarding the further management.

Wishing you good health.

Regards.

Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon.
Above answer was peer-reviewed by
 
Follow-up: Chronic sinusitis. Scan report shows slight deviation of nasal septum and polypoid degeneration. Suggestions? 2 hours later
Thank you! Then I assume the retention cyst doesn't have to be surgically removed. Is it likely to grow larger and cause problems, or that others could develop?
 
 
Answered by Dr. Naveen Kumar 5 hours later
Hi,

Welcome back.

Retention cyst is formed due to obstruction of minor salivary gland located within lining of paranasal sinus. It can grow larger and obstruct the opening of the maxillary sinus, but usually takes years for that to happen.

If there are symptoms of facial pain and recurrent headache on the side of the retention cyst, then removal of the cyst is indicated. It is very unlikely for the other cysts to develop in the same sinus, until there is trauma involved.

Take care.
Wishing you good health.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
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