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Old 06-02-2009, 09:32 PM   #1
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Does anyone know what this means?

My 5 yr. old (almost 6) daughter has recently had a sinus xray and CT and I got a copy of the reports, but don't get to take her to the ENT doctor for a couple of weeks to find out what the impressions mean. I'm very worried about her. She's been to the doctor just about every other month since she turned 3 and she's had enough antibiotics to last someone a lifetime.

The sinus xray was done in march and the impression states: "mucosal disease of the bilateral maxillary sinuses without definite air-fluid level."
The sinus ct was done May 28 (last week) and it states:
"Frontal: Not well formed
Ethmoid: minimal thickening
Maxillary: thickening as well as opacity filling much of the maxillary sinuses.
Sphenoid: Mucosal thickening approximately 50% opacified.
Impression: mucosal thickening and opacification of the right and left maxillary sinuses as well as mild mucosal opacity within the sphenoid sinuses."

She has a lot of allergies... trees, grass, mold, dust, etc. and takes zyrtec and nasonex every day. At the time of the sinus xray, she had just finished 10 days of augmentin and because of the xray report they started her on 2 weeks of cefdinir and 8 days of prednisolone. One month later she starts back up with the same cough that eventually always leads us back to the doctor for more antibiotics. At the time of the sinus ct, she had already taken 2 doses of azithromycin and 2 doses of prednisolone. After the allergist saw her report, she called in cefdinir again and told me to give it to her in conjuntion with the azithromycin. She's now finished the azithromycin and prednisolone, but still has over a week left on the cefdinir. Does anyone have any ideas what could be causing her to stay sick all the time with sinus problems. Oh yeah... back in march she was allergy tested and have been trying to get her started on allergy shots, but she's staying sick all the time and haven't been able to get them started... which they say will help her in the long run, but she is needing relief now! Any body have any ideas of what all this means????? The "mucosal disease" makes me very scared to what that means.
She also has been VERY emotional, easily fatigued, had some weakness in her legs. She does this every time she gets put on these medicines. Does anyone know what could cause that? I've asked her doctors and they all just shrug their shoulders. I'm ready to do whatever it takes to get some answers and help for my baby girl.
Thanks ahead of time for any thoughts or ideas you have to share!

 
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Old 06-03-2009, 03:41 AM   #2
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Re: Does anyone know what this means?

Quote:
The sinus xray was done in march and the impression states: "mucosal disease of the bilateral maxillary sinuses without definite air-fluid level."
The sinus ct was done May 28 (last week) and it states:
"Frontal: Not well formed
Ethmoid: minimal thickening
Maxillary: thickening as well as opacity filling much of the maxillary sinuses.
Sphenoid: Mucosal thickening approximately 50% opacified.
Impression: mucosal thickening and opacification of the right and left maxillary sinuses as well as mild mucosal opacity within the sphenoid sinuses."
The mucus membranes lining her maxillary sinuses (located below her eyes in the cheeks) are inflamed, which causes the linings to be thicker than normal (that the thickening the report refers to) and causes them not to drain correctly. That inflammation can cause sinuses to become blocked and not drain correctly (which is the "opacity" referred to on the report).

It sounds like she has mucosal thickening - probably due to allergies - in the maxillary sinuses and sphenoid sinus (which is located in the middle of her head between her ears).

The thickening can lead to viscious cycle of sinus infections by not allowing the sinuses to drain correctly, which leads to more infections, which can lead to more inflammation.

The term "mucosal disease" doesn't refer to anything specific, but indicates that those mucus membranes are inflamed and aren't functioning correctly.

Much of what she's experiencing could be the result of allergies but, in addition to environmental allergies she should be tested for food allergies (if all of this is due to seasonal allergies there should be times of the year when her problems subside).

You might also consider trying saline irrigation with a pediatric Sinus Rinse bottle to help rinse the mucus and irritants out of her sinuses.

 
Old 06-07-2009, 12:47 PM   #3
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Re: Does anyone know what this means?

Thank you for explaining. It makes sense because of all of her allergies. How can the doctors tell if permanent damage has already occured because of having so many infections and so much inflammation? Is that likely in someone so young? We use a saline spray on her every day, but have never tried the rinses... worried about how she would tolerate it or if it is even safe to use on someone whose sinuses are so inflammed. Also, do you know if it's unusual for an almost 6 year old to not have developed a frontal sinus?

 
Old 06-07-2009, 03:10 PM   #4
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Re: Does anyone know what this means?

Quote:
How can the doctors tell if permanent damage has already occured because of having so many infections and so much inflammation? Is that likely in someone so young?
It's really hard to define "permanent damage" when you're dealing with sinus inflammation. Typically, if the underlying problem can be addressed, the sinuses will start functioning normally again but it may take time and aggressive medical treatment.

Quote:
We use a saline spray on her every day, but have never tried the rinses... worried about how she would tolerate it or if it is even safe to use on someone whose sinuses are so inflammed.
There's really no risk using the rinse. It helps soothe inflammation and works the same way as the spray, just with more volume. SinusRinse has a pediatric-sized bottle that is specifically designed for kids.

Quote:
Also, do you know if it's unusual for an almost 6 year old to not have developed a frontal sinus?
It's not unusual. The frontal sinus develops slowly from the time of birth until 7-8 years and often isn't visible on CT scans in a 6-year old child.

I would recommend that you be sure that the ENT you see is experienced in treating chronic pediatric sinusitis. Her case sound serious enough that a regular office-based ENT may not have the expertise to deal with her situation.

 
Old 06-08-2009, 08:46 AM   #5
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Re: Does anyone know what this means?

Thank you so much for answering my questions. I have had the feeling that I need to take her to a more qualified pediactric ENT. I often doubt my thoughts and decisions regarding her healthcare. You have helped to confirm some thoughts so thank you very much! I just want her to feel better and stop having these chronic sinus issues. It's been 3 years of treating her off and on with antibiotics. I need a doctor who will give me answers instead of only temporarily treating her symptoms and just scratching the surface to what is going on. The only reason she is seeing an allergist or an ENT is because I took that step. After all these years, we were never given direction from our pediatrician to look deeper. I have recently changed pediatricians as well and he is much better at explaining things and seems to be more interested in finding a correct diagnosis.

 
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