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What causes headache, postnasal drip, dizziness and sensitivity to sounds?

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Posted on Thu, 31 Jul 2014
Question: I am family physician with 2 years of nonspecific symptoms, that started in damp rainy weather in New Zealand, where I also surfed in dirty river outlet. Initially 3-4months of low grade fevers, along with abdominal symptoms, then fatigue started and fevers went away. 3months ago (yes over two years now) I was diagnosed with hypopituitarism affecting ACTH,TSH, and ADH, all are low. I am on cortisol and desmopressing and thyroid med. My MRI in 3/14 was read as normal pituitary but right sphenoid air fluid level present. I asked about this and I was told not significant. My symptoms are headache, postnasal drip, weird dizziness and sensitivity to sounds and motion. I had a CT scan of my Sinuses 2 weeks ago, and it showed (I reviewed it in presence of radiologist) total opacification of right sphenoid sinus on coronal view. He did not really show me axial views. Sagittal view showed a homogeneous mass sitting in the floor of sphenoid and creeping upwards to the posterior wall, as a concave mass. He reassured this was not causing any pituitary problem and his final reading was small "sphenoid sinus mucous retention cyst" and bening.He did not comment on the bony structures or other structures. I am also worried due to progressively decrease vision in my right eye over the last 1.5 years, more prominent over last 3 months. What should I do? Get a 2nd opinion on the reading of the CT and MRI? All the other sinuses were normal in the CT scan.
doctor
Answered by Dr. Indu Kumar (31 minutes later)
Brief Answer:
Please upload complete CT images.

Detailed Answer:
Hello XXXX
Thanks for writing to HCM

I have thoroughly gone through your findings in detail.
If possible,please upload complete CT images so that i can interpret the findings in a better way.

Get well soon.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indu Kumar (22 hours later)
Dr XXXXXXX

I was not able to upload the images, not sure how to do it but the disc would not fit my CD drive on my laptop?
Could you comment on the appearance of mucous retention cyst in a CT - would this correlate on MRI air fluid levels? Could simple retention cyst cause complete opacification of right sphenoid on coronal view, and mass extending concavely upwards on the posterior wall of sphenoid?
How could I get the images here?
doctor
Answered by Dr. Indu Kumar (9 hours later)
Brief Answer:
Please find detail answer below.

Detailed Answer:
Hello XXXX
Thanks for writing to HCM

I try to explain the things if there is problem in uploading images.
You have absolutely benign findings.Changes in sphenoid sinus are related to sinusitis.This finding doesn't require any treatment.It is good that other sinuses are normal.

Yes,simple retention cyst may cause complete opacification of right sphenoid on coronal view and mass may extend concavely upwards on the posterior wall of sphenoid in sagittal view.

Any intervention in sphenoid sinus should be avoided because it is dangerous area to intervene.

Your vision problem is not related to sphenoid sinus at all.You need proper examination by a ophthalmologist.There must be some other reasons for dimness of vision.

Mucus retention cyst in sinus doesn't cause any remodelling of bones,so you don't worry about surrounding involvement.

You are taking right treatment.You should continue it.

You can also upload images through drop box and kindly send me link for viewing the images.

Get well soon.
Hope i have answered your query.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indu Kumar (13 hours later)
Dr XXXXXXX

Can you kindly advice how to upload the images to a drop box for you to view them?

Also, please describe the common Ct appearance of mucous retention cyst, and how MRI could help in differentiating it from mucocele?

thank you,
XXXX
doctor
Answered by Dr. Indu Kumar (7 hours later)
Brief Answer:
Please find detail answer below.

Detailed Answer:
Hello XXXX
Thanks for writing back

In CT imaging,there are certain findings which help in differentiating mucous retention cyst and mucocele.
Mucocele causes expansion of bones.It causes bony changes whereas there is no bony involvement in mucus retention cyst.
Mucocele expands slowly and it pushes,compresses,erode bone and moving structures around them.

There is no need of MRI in your case.You can have follow up CT scan.
Most retention cysts of the sinuses spontaneously shrink or don’t change over the long term.

You can send images by opening a account in dropbox.There is option available to upload the images and you can mail URL link to me for viewing the images.

You don't have any serious finding.It is found in many persons even without sinus problem.

Get well soon.
Hope i have answered your query.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indu Kumar (3 hours later)
Dr XXXXXXX

thank you. I did not know about Dropbox. Here is a link now :
https://www.dropbox.com/home
password is : headache.
do you need the username as well? I can change all that info later.

My worry is that I am symptomatic. Now I am getting headaches. I never suffer from headaches nor allergies or sinus symptoms. The headache is on the top of my head and on temporal areas, very intense but hasn't lasted long. It seems worse when I lay down and last night I had it for the first time going to sleep, and waking up. The headaches have been there progressively increasing over last 6 weeks. I have been on the hydrcocortisone now for nearly 3 months.
I surfed and was tumbled in waves in a beach with river outlet that was overflowing after 3 weeks of rain when the symptoms started. That could explain forceful entry of water into the sphenoid. My CT 3 months into the symptoms with low grade fever headaches etc was normal in 2012.

Please let me know if you have trouble getting into the images.

Thank you

XXXX
doctor
Answered by Dr. Indu Kumar (18 hours later)
Brief Answer:
Please send user name.

Detailed Answer:
Hello XXXX
Thanks for writing back

It is not possible to view images without user name.So,please send it.Don't worry,it will be kept confidential.

Get well soon.
Hope i have answered your query.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX
Above answer was peer-reviewed by : Dr. Prasad
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Dr. Indu Kumar

Radiologist

Practicing since :2004

Answered : 6727 Questions

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What causes headache, postnasal drip, dizziness and sensitivity to sounds?

Brief Answer: Please upload complete CT images. Detailed Answer: Hello XXXX Thanks for writing to HCM I have thoroughly gone through your findings in detail. If possible,please upload complete CT images so that i can interpret the findings in a better way. Get well soon. Further queries are most welcome. Take Care Dr.Indu XXXXXXX