Sinus Surgery -- Advice?

[The Inquirer]

Hi All,

In 1998 I had sinus surgery after repeated infections. Officially, this is what I had done:

-submucous resection
-septoplasty (deviated septum)
-partial turbinectomy
-functional endoscopic sinus surgery
-bilateral ethmoidectomies
-antrostomies

OK, so about 2 weeks post-op, I complained of a bad smell up my nose (left side)...I would get what I call "swimmer's sinus" as it felt just like swimmer's ear, but in my cheek area. Finally, it would drain out (without warning, I might add), and then the whole left side would swell up, even though everything came out. i would go through cycles of this. I had some laser work done several times after the surgery. In 2000 or 2001, I saw another sinus specialist who tested for immune deficiencies and also tested the cilia in my nose to make sure it was moving properly. All was normal. He operated to put holes in the bottom of my maxillary sinuses so that mucous could drain down my throat if it was unable to come out my nose.

Here we are now, almost 2005, and they are proposing yet another surgery. My only problem is on the left side and it is primarily swelling, at times becoming infected. He says it is chronically inflamed tissue. The ONLY thing I respond to is steroids, which I love. I looked at the paper he gave me to call the person who schedules the surgeries. He has me down for an ethmoidectomy and a maxillary antrostomy (left side only on both). However, didn't I already have this done? Can it be done again?? If I understand correctly, an "ectomy" is a removal. I know I had my middle turbinates removed. As for what an antrostomy is, I don't have the vaguest notion. Obviously I am going to ask him about all of this, but I thought someone like Chigger or Halls might have some input.

Oh, and just in case anyone is wondering, I can't do the sprays or the washes because they can't even get to where they need to go on that side. Allergy tests are mildly positive for a few things. I am on Clarinex and Singulair currently.

Thanks for any advice,
Inq

[Halls]

An enthmoidectomy is not a removal of the ethmoid sinus, but a opening of the ethmoid. I have had it done 2x now w/no luck unfortunately, but for most it helps a lot. If you are going to get it done I suggest getting stints in place after the surgery to help keep the scar tissue from building up and keep the passages open.

I think you should consider irrigating even though you say washes don't get to where you need. You can learn how to irrigate correctly and it will likely help you.

Also, I would condsider taking something better than Clarinex and possibly a nasal steroid to keep swelling down like NasacortAQ or Flonase. These help me a lot and if I didn't take them my sinus passages would shut completely and I wouldn't breathe very well at all.

Since your allergy test came up positive for a few things maybe you should also consider taking allergy shots. I have been on them for almost 7 months and I it does help most.

It isn't unusual to have to repeat sinus surgeries and sounds like it might not be a bad idea. Removal of any sinuses are usually called obliteration's. I am having one done in Jan. If you feel you need a second opinion don't hesitate to get one just to make sure what your doctor is doing if what is best for you.

Halls

[hoffta]

Inq,

I feel as though I have written your post! Your story sounds about like mine. I had my first surgery in 2000 I think. They did much of what you had done except all right sided.

I started to have problems again about 1 1/2 years ago. I have been on steroids and Levaquin, both oral and through the nebulizer, every other month for about two/three weeks.

My ENT too thought that my cilia was not functioning, but never did give me a report on that. I am in the process of getting my records from the ENT that just did this surgery.

I had staph infection when I had the first surgery done. I have heard that some people need to have surgery every two to five years to just go in and clean everything out.

I had the last surgery done in August and was on antibiotics until about the end of October. I just came down with a sinus infection last week and am now on an antibiotic. I am scheduled for spinal surgery at Hopkins next week and I think I am going to schedule an appointment with an ENT there when I go in for a post op appointment. They are supposed to be number 1 in ENT.

GH

[chigs489]

Inquirer,

repeated use of steroids, either systemic (Prednisone) or in spray form (Nasocort, Rhinocort, Flonase) can cause problems. Prednisone lowers the immune system and makes you prone to infection. The sprays can leave you open to fungal infections of the sinuses, which can be very serious.

I don't use any of this stuff, although I did before sinus surgery in March of this year.

Your doctors need to determine why the tissue is chronically swollen. This could be from a dust allergy, or antibiotic-resistant bacteria. Might also be some fungus. I recommend getting a culture done before doing anything. This is an endoscopic procedure, and only takes a few minutes.

Next, I would start an irrigation routine using a machine. Yes, I know the solution doesn't get to every part of the sinuses (especially the frontal and Spenoid), but it helps clear allergins from the nose, clears away bacteria, and promotes cilia function. If I have an active infection, I put 3ml of hydrogen peroxide in the mix, along with Zyletol and Alkalol. It works beautifully -better than any medication.

You should also start using Sinofresh twice a day.

Treatment options for you include IV antibiotic therapy. I recommend doing this with something like Augmentin or even Vancomycin, if the infection is stubborn. I don't recommend floroquinolones like Cipro, Avelox, or Levaquin, since they have extremely dangerous side-effects.

If you can't get rid of the infection, and surgery looks inevitable, you may want to look into image-guided surgery, a new method using computers, that enhances the probability of success.

There are things you can do. But you need to break the cycle of going back to the same methods that just don't work.

If you are in Illinois, you may want to contact the Center for Advanced Care at Illinois Masonic Hospital. One of the best sinus surgeons in the country works there, and he treats difficult cases.

[The Inquirer]

Thank you all for your replies. Let me see if I can remember everything I wanted to say in response...

I asked my doctor about the stints and he said no. He said that scar tissue can grow around them (?) and that he uses dissolvable packing, so it's not necessary. Sounds like apples and oranges to me, but okay. (I will be going for a second opinio, by the way.)

I understand how helpful the sprays and irrigation tools are for many people. I even have the SinuNeb here. They are just disastrous for me. There's some spot up there where everything gets stuck and pools, and it just gets uglier from there. This is why I no longer put anything up my nose.

Antibiotics are difficult as well because I am allergic to many of them. I generally take Biaxin, Ceftin, or Omnicef.

I am very interested in this fungal infection stuff. I asked my doctor about this several months ago and he said he could tell from my symptoms that it is not fungal in nature (not sure if I believe that, either.) However, keep in mind that my symptoms are not traditional sinusitis symptoms -- I do not have much, if any discharge (only once in a great while and that happens when I go on the steroids usually). It's also never green..actually, if you must know, lol, it's usually clear or flourescent yellow when it's been trapped up there for a while. And it's all ONLY on the left side, supposedly indicating that it is a physical blockage more than anything else. Anyway, I have more questions about these cultures, but I will follow the rules and put them on a new thread.

Thank you all again for your advice.

Chiggins -- sorry I called you Chigger!
GH -- keep me posted on how you're doing, since we seem to share similar symptoms.
Halls -- I will be thinking about you during your upcoming surgery. I pray that you finally get some relief.

Be well,
Inq