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What Does The Paranasal Sinus Report Indicate?

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Posted on Tue, 5 May 2015
Question: Help interpret these two ct paranasal sinus reports and advise what to do next. Been suffering with chronic "nose headaches" for years. I went to an ENT thinking they were sinus related. Got CT scan done in 2009 -report was passed by - somehow ENT never looked at it even though it was in his files. Sinuses were deemed normal, over years pain has worsened. ENT sent me to neuology. Neurological help has not worked. Diagnosed with chronic intractable migraines. Being in so much pain and with no hope, i started looking into disabilty. I requested my medical records for disability from ENT and Neurologist. Saw my CT scan in ENT's file. The findings didnt seem normal, and i know the ENT didnt review them because he wrote on August 13, 2013: "patient has not had any CT or xrays." I went back to this ENT last week. I asked him about the 2009 report. He said he never saw it. I showed it to him. He blamed not seeing it on his coworker and the fact it was a "paper file." He said those findings though, were probably not causing this pain. I begged to differ. I asked to have a new CT scan done - to see if findkngs were still present and/or have worsened. He was reluctant to send me, convinced everythingn was fine, despite my severe nose pain, headaches and the fact they have worsened and become daily and debiliating. I received my new report yesterday. Attached are the two reports. Other symptoms i have include: occassional nose swelling, dryness, freqeunt infections and inflammation, occassional aching in my right eye and ringing in right ear. Pain always starts in nose and occassionally spreads to top of head and neck when severe. Fatigue, severe weight loss (im 5'4 and now 90 pounds), acne - which i never had until few years ago. Im 30 years old, female, caucasion, XXXXXXX with hungarian, dutch and italian descent. Could these findings be potentially causing such pain? What should i do next?
doctor
Answered by Dr. Krunal Karade (1 hour later)
Brief Answer:
In my opinion , your pain is trigger by nose infection .

Detailed Answer:
Hi,
Thanks for the query.

I have read your query ,seen your report and understand your concern.

After reading your clinical history & report it appears that you are most probably having chronic sinusitis with neuralgia . In my opinion , your pain is trigger by nose infection .

In 2009 CT scan report , you are having chronic sinusitis with associated allergy & nasal septum deviated to left .

In 2015 CT scan report , you are having right sided sinusitis with sphenoid sinus involvement with nasal septum deviated to left . Your frontal sinuses are not developed fully .

If I were your treating Doctor for this case , I would advice you
Saline nasal spray or rinse thrice daily ,
Tab Paracetamol for pain with headache &
Antihistaminic Fexofenadine like tab Allegra at night .

You will get relief .

If relief is not upto satisfaction level then you will need antibiotics & Combination Steroid nasal spray with antihistamine 2 puff each nostril twice daily. For which you will need prescription.

Hope it is helpful to you . If you have any further questions I will be happy to help.

Regards.



Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Krunal Karade (14 minutes later)
Thanks so much. Do you think the infection and pain are due to the issues in 2009 not being treated? Im worried about the thickening in the sphenoid sinus. Saline has not helped me over years, actually seems to dry me out more. Do you think antibiotics can clear up the thickening? Will this cyst or polyp need to be removed? As it has been there for years and ive only become more symptomatic. What exactly do you mean by neuralgia? Obstructions in sinuses impinging on nerves, causing nerve pain? Sorry for so many questions. My pain is just so severe, i want to get my life back. Tylenol and regular OTC pain medications no longer help. Even prescription painkillers only ease the pain, very temporarily.
doctor
Answered by Dr. Krunal Karade (57 minutes later)
Brief Answer:
Antibiotics with anti-inflammatory & saline rinse will decrease thickening

Detailed Answer:
Hi,
Thanks for the follow up query.

In 2009 also you are having infection with associated allergy . But now it has involved sphenoid sinus which causes more headache .

I would advice use little more diluted Saline rinse with Steam Inhalation twice daily & tab Allegra at night.

Yes , antibiotics with anti-inflammatory & saline rinse will decrease mucosal thickening .

No need to remove cyst or polyp since it is not blocking sinus opening fully .

Neuralgia is a pain along the nerve distribution due to stimulation . In your case nose infection might stimulating nerve in nose . It may be associated with migraines .

You will need anti inflammatory analgesic like Paracetamol + Ibuprofen combination .

Regards.



Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
Answered by
Dr.
Dr. Krunal Karade

ENT Specialist

Practicing since :2009

Answered : 1000 Questions

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What Does The Paranasal Sinus Report Indicate?

Brief Answer: In my opinion , your pain is trigger by nose infection . Detailed Answer: Hi, Thanks for the query. I have read your query ,seen your report and understand your concern. After reading your clinical history & report it appears that you are most probably having chronic sinusitis with neuralgia . In my opinion , your pain is trigger by nose infection . In 2009 CT scan report , you are having chronic sinusitis with associated allergy & nasal septum deviated to left . In 2015 CT scan report , you are having right sided sinusitis with sphenoid sinus involvement with nasal septum deviated to left . Your frontal sinuses are not developed fully . If I were your treating Doctor for this case , I would advice you Saline nasal spray or rinse thrice daily , Tab Paracetamol for pain with headache & Antihistaminic Fexofenadine like tab Allegra at night . You will get relief . If relief is not upto satisfaction level then you will need antibiotics & Combination Steroid nasal spray with antihistamine 2 puff each nostril twice daily. For which you will need prescription. Hope it is helpful to you . If you have any further questions I will be happy to help. Regards.