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Swollen glands, fatigue, clogged ears, blurry vision, had CT scan, had surgery for sinus infection. MRI?

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In January had sinus surgery, since then have had a sinus infection every month. In July got sinus infection that wont respond to antibotics. My symptons include swollen glands, extreme fatigue, facial pain, clogged ears, burry vision. Finally got a ct scan which showed a pockect of infection that was missed. I had surgery two weeks ago and I still have swollen glands, extreme fatigue, and facial pain. What could possibly still be wrong? I think I should request an MRI?
Posted Mon, 23 Apr 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 2 hours later

Thank you for your query.

1. If you can share your CT Scan images, it will be possible for me to comment exactly on the sequence of events. An MRI probably has an advantage of detecting fungal infection and having less radiation. Otherwise a CT Scan is the gold standard imaging because MRI cannot visualize bone. I will recommend an MRI for the above reasons only and if no relief is seen in the coming few weeks.

2. During FESS or Functional Endoscopic Sinus Surgery, the maximum amount of tissue and mucosa is preserved. The principle is that once adequate ventilation is achieved, healing will take place and revert the changes in the nose and sinuses. Our body's natural defense tries to close all the openings thus created such that a large 1-2 cm opening may finally become only 0.1 - 0.2 cm after healing is complete. This, along with adhesions and synechiae creates frequent problems (in up to 25-40% patients post-op).

3. I would also like to introduce you to the concept of Biofilm formation in your nasal passages and sinuses. There may be associated allergic, fungal and mucus related conditions. The simplest example of Biofilm is the sludge or slime seen in drainage pipes or the moss seen along water channels. The Biofilm represents colonies of different types of bacteria, fungi living together like a 'city' with different micro organisms taking up different tasks or "profession's" like we do in our communities. Some of them secrete a matrix that protects them all. Due to close proximity, these organisms share genetic material and may be genetically distinct from those that are grown in lab cultures. Hence they do not respond to the same antifungals and antibiotics that they show sensitivity to in lab studies.

4. You should wash your nose and sinuses with a solution of normal saline with a pinch of salt and baking soda added to it. This alkaline nasal douche will help break up the Biofilm and allow penetration by other medicines. You may add a few drops of anti-dandruff shampoo which contain undecylenic acid, which is a natural fungicide, besides some brands contain ant-fungals such as ketaconazole. Use a steroid nasal spray such as fluticasone or ciclesonide. Steroids should be given under antibiotic cover.

5. Hopefully, the second look surgery has achieved surgical debridement, removal and disruption of the Biofilm. The immediate healing period is four to six weeks. Local swelling will subside till then. Scabs, adhesions, synechiae and nasal obstruction is common, requiring regular follow up and endoscopic cleaning. XXXXXXX healing and fibrosis may extend up to six months from the time of surgery.

Hope I have answered your query. Awaiting your reply.

Above answer was peer-reviewed by
Follow-up: Swollen glands, fatigue, clogged ears, blurry vision, had CT scan, had surgery for sinus infection. MRI? 10 hours later
Unfortunately, I do not have the CT Results. The second surgery was to clear the pocket of infection in the cavity on the right side of my face next to my eye.

I know there is time to allow for healing but I dont feel any better. I have very bad swollen glands, accompanied by extreme fatigue along with headaches and facial pain throughout my face. The pain is not in one particular spot. Sometimes it is in the right side of my face - then will move to a headache in the back of my head. There is a ton of pressure around my ears and tender to the touch.

Shouldnt I be feeling at least some relief? Why would my glands be swelling if the infection is no longer present? (my ent said that there were no signs of infection at my post op appt)
Answered by Dr. Sumit Bhatti 3 hours later

Thank you for writing back.

1. If you have the resources, demand an immediate CT PNS / MRI and share the images (not the report) for an accurate assessment.

2. If you do not have the resources, insist on adequate medication based on swab cultures. All your symptoms point to continued inflammation and infection post-op. In particular, blurry vision is worrisome. Is there any fever? Any neck stiffness?

3. You might have a super-added viral infection. However even that should be controlled by appropriate medication. Yes, you are correct in stating that if there is absolutely no relief, or if you are feeling worse off after surgery, then it should be investigated. Did you have an endoscopic exam on post op follow up? Have any post op blood investigations been done?

4. I would recommend an indoor admission with intravenous medication if your scan shows massive inflammation or swelling. You may also request for an Ultrasound Neck for assessing the lymph node swelling.

Awaiting your reply,

Above answer was peer-reviewed by
Follow-up: Swollen glands, fatigue, clogged ears, blurry vision, had CT scan, had surgery for sinus infection. MRI? 4 hours later
My next appointment is not for another two weeks. But I cant wait. I will call tomorrow and demand to be seen and to be sent for another CT or MRI.

I told him last week that I had blurry vision and he said it was part of the healing. He said the blurry vision is because of where the infection was - near my eye socket. Also advised him of the swollen glands - but he said this is part of the healing.

No i do not feel any better. When my glands swell it is also accompanied by body aches and extreme fatigue. I dont have a fever but I feel warm to the touch.

All of symptons, swollen glands, body aches, fain in face - eyes, ears - tenderness to the touch ..I even have pain in the back of my head. I have told him. All of these sypmtons have been present since the end of XXXXXXX The day after my surgery two weeks ago is the only day I felt good. Besides tired from surgery - no pain or swollen glands.

On my post opt exam he cleaned out the nasal cavities and said there is no infection. No post op blood work has been done. I will request it tomorrow.

Thank you for reassuring me that im not losing my mind. I'm really feeling depression from feeling so sick all the time.
Answered by Dr. Sumit Bhatti 13 hours later

Thank you for writing back.

1. The sinuses have a large surface area. Toxins produced due to any infection and inflammation in the sinuses are hence quickly absorbed into the blood stream and cause that sick feeling. Hence it is important that you go ahead with the above mentioned tests.

2. The virulence of the infection can cause such flare ups after surgery, especially when the body has walled off the offending organisms and surgery releases them into the blood stream. I hope that you do not have any immunosupressive condition such as diabetes.

If cultures (local and blood) are negative, it is good news, but fungal and viral infections may not show up easily. The chances of this being a drug reaction exists, but is very low.

3. You may share information about your results and clinical condition in real time here.

Wish you a speedy recovery.

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