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Suggest Treatment For Headache, Ear Infection And Jaw Pain In A Child

Posted on Tue, 2 Feb 2016

Question: XXXXXXX XXXXXXX 8 years old has problem of headaches. She has dust allergies, Ear infection and jaw pain occasionally and has weak eyesight. MRI reports showed sinus though doctors were unaware of its fungal but assumed it to be bacterial as the blood test results were showing controlled infection after 2 courses of anti biopics. We saw an ENT specialist who recommended Adenoid and tonsils surgery. We wanted 2nd opinion and when saw the 2nd ENT surgeon she adviced sinus drainage/washout and told that the Adenoid tissues do look inflamed but every person with dust allergies and sinusitis has some inflammation of these tissues so that should not be our worry. She mentioned a pterygoid lesion on right side close to the vision nerves and the bone that helps in chewing. She thought if we leave this pterygoid lesion and it increases in size XXXXXXXX may have issues of blurry vision and chewing. So booked an operation for sinusitis washout and Excision of pterygoid lesion. We are satisfied for the sinusitis washout but concerned for Excision of pterygoid lesion as no where in MRI and CT scans the radiologist mentioned if there was any kind of cyst or pterygoid lesion and it's only the ENT surgeon who noticed it. She might be right but in case she is not right we don't want in necessary pricking at the spot where she doubts is a pterygoid lesion.I have blood reports and MRI films too but I'm not ablke to upload as your website is not uploading more images, please advice if you need for more information or I tell me your email address where I can email the reports but I don't think I'm able to send MRI films
Thanks

Answered by Dr. Hariom Sharma (2 hours later)

Brief Answer:
Go for An operation For sinusitis washout and excision of pterygoid lesion

Detailed Answer:
Hi,
I have gone through your query and reports; and I agree with your doctor that advised an operation for sinusitis washout and excision of pterygoid lesion.

According to my best of knowledge, she is right.

Faith on your doctor.

Thanks

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Hariom Sharma (14 minutes later)

My concern is not the sinus washout but the cyst. Nowhere in MRI and CTscan reports the radiologist has mentioned the presence of cyst and doctor thinking its a cyst based on the images. Can you give me an idea about the nature of the cyst looking at the image?

Answered by Dr. Hariom Sharma (6 hours later)

Brief Answer:
Benign nature of the cyst

Detailed Answer:
Hi,
I have gone through your follow up query; it suggests that the nature of the cyst is benign.

No need to worry.

Regards
Dr Hariom Sharma MS, XXXXXXX

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Hariom Sharma (3 hours later)

The first surgeon suggested just to operate tonsils and adenoid. He didn't advice for removal of cyst or any washout. According to him sinus is drained on its own when adenoid and tonsils are not inflamed.I wanted to know can this cyst be left there and not removed as it's harmless. I'm worried as it has some very important nerves around it. As its only in images and radiologists have not mentioned it anywhere is it possible its not even a cyst or something as a result of sinus or clogged head?

Answered by Dr. Hariom Sharma (9 hours later)

Brief Answer:
I am fully agree with the opinion of second doctor

Detailed Answer:
Hi,
I have gone through your follow up query; and for your kind information
1. When the sphenoid sinus exceptionally large they may extend into the roots of the pterygoid processes, and may invade the basilar part of the occipital bone.
2. Complication -A potential complication of sphenoidal sinusitis is cavernous sinus thrombosis.
3. If the sphenoidal cyst or pterygoid lesion is left there then cavernous sinus thrombosis or related complications may occur such as diminished vision, double vision, loss of vision, drooping eye lid, severe headache, siezures etc

Just go through CT scan report of PNS and they already mentioned that
1. There is complete opacification of the sphenoidal sinuses bilaterally.
2. Adjacent the right sphenoidal there is an area of pneumatisation and bone expansion through the right sphenoidal bone. This area appears to communicate with the sphenoidal sinus.

Regards
Dr Hariom Sharma MS, XXXXXXX

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. Sonia Raina