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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes persistent headaches after a surgery for orbital cellulitis?

My 14 year old daughter had two emergency operations within 2 weeks for orbital cellulitis in April/May - the result of ethmoid sinus infection. At the time of the first op. the optic nerve was compressed, vision at risk and she became systemically ill very quickly. The first op was FESS only, the aim being to let the infected eye drain down through the cleared pathway. It wasn t successful. After two weeks CT scans showed infection back in the cheek and the eye was still proptosed and vision not good. During the second op -- FESS plus this time an external incision below her eyebrow -- her cheek and area surrounding the orbit were cleaned out with hydrogen peroxide. She was left with a totally numb forehead and after 11 weeks sensation has still not fully returned. She is still suffering headaches, plus chronic exhaustion -- we appreciate that exhaustion was to be expected after two lots of anaesthesia, massive doses of IV antibiotics, oral steroids (on oral steroids only for first post-op days, on antibiotics for some weeks). But why is she still suffering headaches and nerve pain -- this consists of the typical burning/crawling sensation, like ants, plus electric shocks in her scalp, disturbed sleep. When some sensation does return, e.g. around her eyebrow, this is often accompanied by a headache, but areas of her forehead are still numb. She finds it hard to concentrate and retain information, she feels woolly headed. She sleeps endlessly. Post-op ENT prescribed a daily nasal wash plus Avamys (fluticasone) inhaled steroid spray two in each nostril daily. She takes parcetamol for headaches. With her ENT doctor s consent (by phone and via his secretary) yesterday we stopped the Avamys spray as she d begun experiencing the common side effect of nose bleeds -- not good after sinus surgery. Questions: 1) Should we ask our GP to refer her to a neurologist? (We can t get to see the NHS ENT surgeon again til September.) My daughter is not keen to be offered or take strong medication that has not been tested on children, but do we need a specialist neurologist opinion about the continued headaches/nerve pain/numb forehead/exhaustion? Can anything other than drugs help, e.g. is there any evidence in favour of something like cranial osteopathy? 2) Can Avamys cause hair loss after, say, 11 weeks? In the past 2 weeks my daughter has begun shedding hair. 3) Could my daughter be more sensitive to rarer side effects of the inhaled steroid -- she is overweight and is 5 foot 11 tall at age 14 and because of an off the chart sudden height/weight gain at age 11/12 had endocrine investigations for PCOS, thyroid etc -- all negative, but she is insulin insensitive. Apart from the recent heavy nose bleed and hair loss she has been feeling very nausous for about a week. We will continue with the daily nasal wash but not the inhaled steroid. The good news: The ophthalmologists are happy. While both eyes are still not completely aligned as tissue healing continues, the optic nerve is unimpaired and vision is good.
Tue, 28 Jul 2020
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Otolaryngologist / ENT Specialist 's  Response
Hi,

I can tell you some of the reasons for her frequent headache:
1. The sinus opening may be narrowed due to improper healing
2. Numbness of forehead is due to damage to the nerve called supraorbital nerve which supplies sensation of forehead it may happened when there is an incision made below eyebrow to drain pus
3. Intra-nasal steroid spray provides only microdose of steroids.

Do this:
1. Continue nasal douche
2. Do nasal endoscopy to see opening of sinuses are patent
3. Try to hydrate nose using saline nasal spray
4. If there is any nasal bleed apply ice pack, pinch the nose and head down with chin touching body and mouth should be opened
5. Be cool and relaxed

Take care. Hope I have answered your question. Let me know if I can assist you further.

Regards,
Dr. Greeshma K. Menon, Otolaryngologist / ENT Specialist
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What causes persistent headaches after a surgery for orbital cellulitis?

Hi, I can tell you some of the reasons for her frequent headache: 1. The sinus opening may be narrowed due to improper healing 2. Numbness of forehead is due to damage to the nerve called supraorbital nerve which supplies sensation of forehead it may happened when there is an incision made below eyebrow to drain pus 3. Intra-nasal steroid spray provides only microdose of steroids. Do this: 1. Continue nasal douche 2. Do nasal endoscopy to see opening of sinuses are patent 3. Try to hydrate nose using saline nasal spray 4. If there is any nasal bleed apply ice pack, pinch the nose and head down with chin touching body and mouth should be opened 5. Be cool and relaxed Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Greeshma K. Menon, Otolaryngologist / ENT Specialist