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Old 07-18-2011, 10:09 PM   #1
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Deciding on surgery for chronic sinusitis

After suffering with chronic sinusitis for a while it has been reassuring reading some of the other posts here and seeing Iím not alone. Iím currently at a point where Iím deciding on surgery and Iím hoping somebody else may have a similar situation and have some advice.

I started having problems a year ago, I began feeling pressure in my head (always starting in the corner of my left eyebrow), usually starting in the afternoon. I'd also end up with post nasal drip and a rundown feeling that would last the rest of the day. This continued for weeks, I hoped it would clear up on its own but I continued to get worse. I came home every day feeling horrible, the pressure in my head felt like it spread around my face. Causing around my eyes to feel puffy and swollen. I also started getting stomach pain, which got worse throughout the day. After over a month I gave in and went to my PCP who diagnosed a sinus infection and put me on an antibiotic. Almost immediately I began feeling better. All the symptoms went away. I continued to feel fine for several months until slowly the pressure returned in the same place. Eventually all the earlier symptoms returned and I went back to my doctor. Again I was put on another long course of antibiotics but this time I didnít get better. I would feel okay for a few days and then get sick again. After a 2nd round of antibiotics I was sent to an ENT.

I should also add that Iíve been tested for allergies (twice) and was negative for everything. Iíve also tried just about every kind of nasal spray and antihistamine on the market with no results. (Nasal sprays just go right down my throat)

The ENT had me go for a CAT scan which showed my sinuses were clear. The only thing noted in them was a slight deviated septum and ďMucoperiosteal thickening in the ethmoid air cellsĒ. The ENT had me try a saline rinse with Pulmicort added to it. After a week I began noticing improvement, instead of feeling sick every day I would feel okay for a few days then have a bad day. It also reduced the severity of the symptoms. But it was still not a full cure so my ENT had me try other options. I tried oral steroids but didnít see any improvement, I also tried another round of antibiotics while doing the nasal rinse. But after I stopped using the Pulmicort I only got worse. Iím back on the Pulmicort now, doing a little better but still feeling ill several times a week. My ENT told me he feels like weíve tried all our options and heís suggesting surgery, though he told me he canít promise results. Which has made me feel very uneasy.

Iím nervous having surgery performed by a doctor whoís not sure itís going to work. Iíve been sick for almost a year and Iím exhausted. This has affected my work and home life because I never feel like Iím at 100% and by the end of the day Iím just trying to keep my head up and wait until I can get home to crash. Iím terrified Iíll have the surgery and it wonít work because I honestly have no idea what to do after that. Any advice offered would be greatly appreciated. Thanks!

 
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Old 07-19-2011, 09:24 AM   #2
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Re: Deciding on surgery for chronic sinusitis

Quote:
The ENT had me go for a CAT scan which showed my sinuses were clear. The only thing noted in them was a slight deviated septum and ďMucoperiosteal thickening in the ethmoid air cellsĒ.
Have you had another CT Scan since the first? Based on the findings of the first CT scan, there's not much for the surgeon to really do other than correct your deviated septum (which probably won't help) and possibly remove some ethmoidal tissue (which might help a little). Did the doctor specify what he would do in the surgery?

If there's not a clear reason for the surgery I would recommend against it. It's unlikely that just having some tissue removed is going to solve your problem (since you don't know what is causing it).

 
Old 07-19-2011, 07:32 PM   #3
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amarieh HB User
Re: Deciding on surgery for chronic sinusitis

I have only had the one CT, which was about 7 months ago. It was done while I was on the antibiotic which the doctor mentioned might be why it didn't show much. There was also was something called Bilateral Haller cells found which could be causing some of my sinus problems. Surgery would be needed to remove that.

 
Old 07-20-2011, 03:05 AM   #4
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Re: Deciding on surgery for chronic sinusitis

The presence of the Haller cells may indeed justify the surgery, but if your sinuses are clear I'm still not sure what your ENT is proposing to do surgically. Is he just going to remove the Haller cells?

There are a couple of things you should consider:

-Sinus surgery is only effective if there is a specific issue that it is addressing (removing polyps, Haller cells, etc.), and any known underlying cause of the symptoms (allergies) is being addressed. If the doctor isn't sure what is causing your symptoms, he's just guessing and it would seem to be better to get a second CT scan to confirm the correlation between the Haller cells and your symptoms than to just remove them and hope for the best.

-Removing too much tissue can cause as many problems as not removing any. Some ENTs like to trim turbinates and make openings larger because it seems like it would help when it can actually cause mucus recirculation and other problems that are just as annoying as what you're going through now.

Before you proceed with the surgery I'd recommend you do 3 things:

1. Get a second opinion from an ENT at a major teaching hospital who specializes in the treatment of chronic sinusitis (most office-based ENTs don't see enough complicated cases to really be experts in cases like yours that don't respond to conventional treatment).

2. Know EXACTLY what your surgeon is planning to do and understand his philosophy of surgery. You do not want an aggressive surgeon, you want one who is going to address your specific issue with minimally invasive techniques that leave as much of the natural tissue and drainage pathway in place as possible.

3. Ask your surgeon about his plans for post-surgical follow up. If he doesn't plan to see you at least twice in the month after the surgery for debridement (removal of scabs to prevent scarring) and to check that things are healing properly, find a new surgeon. Post surgical follow up can be just as important as the actual surgery.

It's not an easy call in your situation given the lack of a clear cause for your symptoms, so it's probably with the extra time and effort to get some additional information before you decide.

 
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