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What causes severe pain and pressure on forehead above eyes with normal MRI?

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Dr. T Chandrakant

General Surgeon

Practicing since :1984

Answered : 16405 Questions

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Posted on Wed, 6 Aug 2014 in General Health
Question: I have chronic sinusitis for over 30 years,it has become progressively worse,never clearing without antibiotics,corticosteroid nasal sprays,neti pot etc.In past few years I,ve been getting regular fluid in my middle ear,vertigo and tinnitus,some hearing loss.My doctor says I have bilateral scarring on my eardrums.My first consultant said my MRI scan showed clear sinuses.My doctor is keen for me to see another consultant and ask for FESS procedure,I get very ill with sinuses and this concerns her.What do you think I should do?I,ve tried reducing dairy products,wheat,and drink pints of water daily.Nothing helps.
doctor
Answered by Dr. T Chandrakant 1 hour later
Brief Answer:
Endoscopy of ENT- CT of Mastoids.

Detailed Answer:
Hi.
Thanks for your query.

First of all I would like to know your exact symptoms, the way they started 30 years back, through the last 30 years and now - at the moment.

If the first consultant has said that MRI shows clear sinuses, it must be true.
If the sinuses are clear, there is no role of FESS. If the sinuses are clear on MRI , there is no chronic sinusitis.

I would advise such patient the following:
Clinical examination and endoscopy of the ears, nose and throat. This will make clear the diagnosis.

CT scan of the mastoids to determine the exact extent the ears have suffered .
Blood investigation - Complete blood picture, Sugar, thyroid function tests,
X-ray chest

You may please the photos of the ENT Endoscopy , if you have attached to this query.


Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. T Chandrakant 4 hours later
Thank you for your opinion. In reply to your query about my symptoms and how they have progressed through the years my history is as follows.I got my first sinus infection at 16years of age. I presented with severe pain and pressure on my forehead above my eyes,severe congestion where I couldn't blow my nose,post-nasal drip,general flu-like symptoms.In the early years the attacks were not frequent but by the time I was 22 years old I had had a sinus wash out done under general anaesthetic. The symptoms returned and sinus infections became more frequent. Any discharge that would come from my nose would be green, then yellow,then blobs of clear mucous,as thick as jelly. I always feel as if the mucous is stuck in my nasal tubes under my eyes and close to the bridge of my nose.My doctor said yesterday that mt right eye and cheek were sore and slightly swollen as a result of thr infection.I do steam inhalations,have taken kyolic garlic extract-you name it I,ve tried it.My haemoglobin is normal, my weight is approx. 145 pounds and I'm 5ft 8inches in height, so weight isn't a factor. My diet is healthy,I eat plenty of fresh fruit and vegetables.I have reduced sugar intake with very little positive effect. I take echinecea drops for short periods of time to try to boost my immune system. I also take B-complex,vitamin C and other supplements to try to fight infection. In the past three years I also get migraine with the sinusitis, not always but it does happen when the pressure in my face and head is very severe. My doctor feels that my nasal tubes are likely narrowed from a build up of gunge over the years and scraping this away might help.The bridge of my nose is very narrow and my nasal openings are very narrow.A plastic surgeon did have a look at this to see if he could do anything to improve the openings ,but,although agreeing that I definitely had extremely narrow bridge and nasal openings he didn't feel that he could improve the situation with plastic surgery. I do have a slight deviation of my septum on the left side but the first consultant didn't consider this of great significance.But ny doctor and I are in no doubt that I get sinus infections-what comes out of my nose and what I cough up after lying flat for the night are testament to that. Just three months ago I was diagnosed with a thyroid disorder..my RT3 was a problem.This is not tested in XXXXXXX so my neuroendocrinologist,Professor XXXXXXX Darragh, sent my blood to France for analysis.The ratio of Free T3 to RT3 is supposed to be over 20. Mine was 2.4.I'm now on Liothyronine,Thybon brand, 30mcg daily. The improvement in my ME,which I've had for 2 years, has been remarkable.I have always been symptomatic of hypothyroidism but because the basic thyroid tests fell just within the bottom end of "normal range" I was never treated for a thyroid problem.Finally I have always had gastric problems,acid reflux over the years treated with Lo-sec etc. In January of this year I collapsed and was rushed to A&E-turned out a gastric ulcer had had a significant bleed, causing the collapse.My stomach hadn't been giving any great bother at the time, so we were greatly taken aback. My blood count was 7, so I was given 2 units of blood, and bags of fluids to stabilise me. An endoscopy confirmed a gastric ulcer, my colonoscopy was clear, A repeat endoscopy 8 weeks later showed the ulcer had healed, though I had slight inflammation in the duodenum.I take 375mg of Effexor XR daily as I suffer with PTSD, having been violently ohysivally and sexually abused from age 4 to 17 approx.I'm in no doubt that my emotional problems have affected my physical health. Yet I can't help but wonder could a surgeon not scrape or widen ny nasal passages , thereby allowing me to clear my nose. As I said I take lots of fluids. Sorry about the length of this but its an old and very frustrating story. Your opimion would again be appreciated. Thanks, XXXXXXX XXXXXXX
doctor
Answered by Dr. T Chandrakant 3 hours later
Brief Answer:
Investigations and second opinion.

Detailed Answer:
Thanks for your feedback.
Read and re-read the history provided by you.
I was wondering if all these things have to do with your problem under discussion.
I was thinking of a condition called ''vaso-motor rhinitis''. This can lead to all the symptoms you have once there is super-added infection.

I would advise you the following, may be as already suggested :
Get the second opinion of another ENT Surgeon for Clinical examination and endoscopy of the ears, nose and throat. This will clear the diagnosis.

CT scan of the mastoids to determine the exact extent the ears have suffered .
Blood investigation - Complete blood picture, Sugar, thyroid function tests,
X-ray chest
And a fresh contrast enhanced CT scan or MRI of the nose and sinuses to know the exact position of the problem.
The secretions if present: have to be sent for microscopy- gram staining, culture and sensitivity. This may help in diagnosis and further management.

Let us see the reports ten decide further.
Till then please continue all the medical treatment you are already on.

Dr T Chandrakant
ENT and General Surgeon
Above answer was peer-reviewed by : Dr. Prasad
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