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Suffering With Severe Headaches, Nausea With Vomiting. Ear Pain. MRI Showed Mucosal Opacification Of Sphenoid Sinus. Concerned?

Posted on Sat, 19 Oct 2013

Question: I've been suffering with severe headaches, nausea with vomiting and a pulsating "whooshing" sound in my ears (more often in my left) which will subside if I place a finger over my carotid artery. I've had fullness and pain in both ears and had tubes in my ears as a toddler. My adenoids were removed when I was an infant. I'm thirty years old, female. I had an MRI without contrast of my cervical & lumbar regions because of a car accident I was in. Along with three herniated disks in my neck, and reversal of the cervical lordosis, there was an incidental finding (of the Paraspinous Structure)s noted: "appears to be mucosal opacification of the dorsal aspect of the sphenoid sinus consistent with mucoperiosteal disease thereof". As well as: "There appears to be a simple retention cyst of the Fossa of Rosenmuller." I do not know what these things mean. The primary care doctor who ordered the MRI recommended I find a Neurosurgeon for my back problems; however, he mentioned nothing about the Paraspinous Structure findings. Should I see an ENT specialist or is this find of incidental finding in the Fossa of Rosenmuller typical? Is this something I should be medically concerned about? The headaches are debilitating and the pulsating sounds in my ears and fullness are bothersome and troubling. As far as family history in concerned, my brother was diagnosed with a Right Cerebral Hemisphere lesion which has increased in size; he begins treatment for it this week. My brother and I both always had ear troubles when we were children. Should I be concerned given the findings and my family history? Thank you for your time.

I also have burning-type pain on the left side of face in my eye area and weakness in my left leg

Answered by Dr. Dr. Prasad J (5 hours later)

Brief Answer:
You will need both....

Detailed Answer:
Hi,

I went through your post with diligence. It appears that you are suffering from severe headache, nausea and vomiting along with "pulsatile" tinnitus. The MRI scan of cervical region revealed mucoperiosteal opacification of sphenoid sinus and a retention cyst of fossa of Rosenmuller.

I understand the symptoms are troubling you. In my opinion you will need to see both ENT as well as neurosurgeon. The reasons being:

1. Retention cyst in the Fossa of Rosenmuller is an asymptomatic harmless condition. Most ENT doctor don't treat it; they would prefer to wait and watch. However mucosal opacification of sphenoid sinus might be due to sphenoid sinusitis which may be responsible for headache and vomiting. An ENT surgeon will be able to correlate symptoms and signs with MRI reports to exclude sinus inflammation.

2. Whooshing sound which disappear by pressing on carotid artery is called pulsatile tinnitus. I refer my patients to neurosurgeon after checking blood pressure to exclude carotid artery vascular abnormalities. Carotid artery doppler study / angiogram test is in order.

Burning pain on the left side of face and the weakness may or may no be related.

In short, I am a bit concerned; not because of what is seen on MRI cervical spine, but due to the nature of your symptoms. I would definitely urge you to get this sorted at the earliest. Visit the ER if your GP is unable to figure the reason.
If the headache and vomiting is not as bad as I perceive, you can fix an appointment with both - neurosurgeon first and next ENT surgeon.

Hope this helps. Let me know if you need clarifications.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Prasad J (9 hours later)

I've tried to get an appointment with ENT. However, the earliest I can get is in one month. As of today, I have stopped vomiting and am able to hold down liquids; though, I still have the headaches, though not as severe as yesterday and I'm still getting pulsatile tinitus. I'm frightened of the ER. Should I wait for the appointment with ENT in one month or should I push to be seen sooner?

Answered by Dr. Dr. Prasad J (16 minutes later)

Brief Answer:
We can wait for an appointment...

Detailed Answer:
If you are feeling better now then you can skip ER visit. Tylenol might help in controlling headaches until you visit the doctor. You can use it thrice a day for the next 3-5 days and thereafter as and when required.

If you are able to push for an early appointment, it would be better. I expect Tylenol to help you until then, if not you are free to write back to me.

Also discus avoid neurosurgeon referral with your doctor after ENT visit.

Hope this helps. You can close this discussion if you there are no more follow ups.

Best wishes

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. Chakravarthy Mazumdar