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Old 07-22-2011, 04:57 PM   #1
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Having ethmoidectomy and sphenoidectomy in a few days

I was having severe headaches about a month ago and an MRI revealed that the most likely cause was a severe sphenoid sinus infection (it was completely opacified). I don't believe there were any polyps. There was also a little bit of congestion in the ethmoid sinuses. The headaches went away on their own after about 2 weeks (I was prescribed anti-biotics, but the headache seemed to have been slowly going away before I even had the anti-biotics). It was the worst headache I had ever had. But even after the headache went away, my ENT told me that the actual infection/congestion will still be there for a long time (he said it could take anywhere from 6 moths to 2 years for it to fully be healed on its own). A few weeks ago, I noticed that a similar headache had begun to reemerge. It wasn't as severe, but the fact that it was there at all concerned me. I spoke to my ENT and we decided to have surgery. I'm scheduled to have it next Wednesday and it will be a bilateral ethmoidectomy and a sphenoidectomy.

I'm wondering if anyone has had either of these surgeries performed? (I'm more worried about the sphenoidectomy since it seems rarer). I wasn't really worried at all. My ENT (who is also the surgeon) told me that due to the packing (which would eventually be absorbed by itself), I will be in severe pain for 3-4 days after the surgery but I would be fine after that. He also said it was a relatively simple procedure and that I would most likely be able to go home the same day.

But now I've read some old threads on here saying that sinus surgery is pretty severe and that it can take weeks or even months to recover. So I just wanted to know if there was anyone who can tell me about their experiences with these specific surgeries.

 
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Old 07-23-2011, 12:06 PM   #2
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Re: Having ethmoidectomy and sphenoidectomy in a few days

I've had both procedures but there are several things in your post that concern me.

First of all, are you sure you had an MRI and not a CT scan? Most ENTs prefer CT scans because they do a better job of showing the bony structures (which MRIs don't show as well) - If you really had an MRI your doctor is a bit unconventional.

Second, I'm hoping there's more to your story than just one round of antibiotics then a decision to have surgery. It is extremely rare for a doctor to recommend surgery after just one round of antibiotics if there are no polyps or other mechanical obstruction causing your problem. Your doctor should AT LEAST have tried putting you on oral steroids to shrink any inflammation, with an extended course of antibiotics based on culturing the infection before recommending surgery. If that didn't happen, I would absolutely recommend that you get a second opinion because surgery should be a last resort.

Third, I can tell you that his comment that it takes 6-months to 2-years for the area to fully heal on its own is just plain wrong. It does take time after the antibiotics for the inflammation to completely resolve, but that amount of time is more like 5-10 days, not 2-years.

Fourth, the comment about being in severe pain for 3-4 days is just plain wrong (or at least is extremely uncommon) as well. I have had very severe sinus issues for 15 years and have been extremely fortunate to be treated by 2 of the best ENTs in the U.S. In addition to the two procedures you're having and the endoscopic modified Lothrop procedure (which is about as serious and invasive a sinus procedure as can be performed) I've had polyps removed multiple times (a total of 5 sinus surgeries), and I was never in severe pain after any of the procedures. The worst pain I experienced was similar to a moderate, but annoying, headache.

Finally, the packing comment troubles me as well. Most ENTs have moved away from the use of packing in sinus surgery. I had packing that was removed by the ENT in the first two procedures within 24 hours, both of which were 10+ years ago, but no doctor has used packing in any of my procedures since then (and I've never even heard of a doctor using packing that dissolves for sinus surgery).

There are 3 things that I would strongly encourage you to do:

1. Get a second opinion from an ENT who specializes in the treatment of sinus disease. Most office-based ENTs treat lots of different maladies and some don't have the expertise to diagnose tricky sinus problems, and many don't perform these surgical sinus procedures often enough to really be experts in them. The first ENT I saw was a brilliant office-based ENT who was wise enough to tell me that my case was beyond his ability to manage so he referred me to an ENT at a teaching hospital who treats nothing but sinus disease, and I have been forever grateful to him for being honest about that fact.

2. Before you have the surgery exhaust all of the non-surgical medical options, including an extended course of antibiotics, oral steroids and the regular use of saline irrigation (of course you may need to find a doctor who's not so gung-ho to operate). Surgery really should be the last resort.

3. Get detailed information from your surgeon about his plans for post-operative care. It should involve weekly follow up visits to debride (remove scabs and dried mucus) the area that he operated on. Most ENTs will do this at least 2-3 times to help minimize scarring and inflammation after the surgery. The doctor should also expect you to do saline irrigation starting 24-48 hours after the surgery (which wouldn't be possible with packing left in your sinuses). The irrigation also helps remove dried blood and mucus.

The post surgical follow up regimen is as important as the surgery itself, and if your doctor doesn't follow that procedure, I would look for another doctor.

I know that's a lot to digest, but I would really encourage you to get a second opinion and take your time making this decision.

Last edited by gcsjr; 07-23-2011 at 12:07 PM.

 
Old 07-23-2011, 02:44 PM   #3
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Re: Having ethmoidectomy and sphenoidectomy in a few days

Damn it, I had written up a lengthy response to your post but I accidentally pressed refresh or something and now it's all gone

Anyways, thanks for the reply and here's some more information:
The MRI was ordered by a family doctor who didn't know whether or not the headache was actually sinus-related.

I had similar headaches 2 years ago and instead of going to an ENT, we went to a neurologist at that time. (Again, we didn't expect it to be sinus-related). After diagnosing it as a sinus infection, I was put on one course of anti-biotics and the neurologist never followed up again or referred us to an ENT.

This time, my ENT put me on 500 mg of Biaxin (twice a day) for 3 weeks. In addition to that, I was taking Sudafed, Allegra, using a neti pot daily, and used a nasal spray for a few days. After about 3 weeks of that, I had felt fine and it was to the point where the only medicine I was taking was Allegra once a day (the doctor prescribed Allegra after a blood test confirmed that I had allergies and he thought that might have been the cause of the infection). So after taking that course of treatment, I felt perfectly fine for about 2 weeks until the headache reemerged. The headache has been there constantly for the last 2 weeks. It comes and goes, and varies in intensity (although never as painful as before), but the fact that it is still there concerned me and my parents.

After about a week of thinking about it, my parents and I decided that we would like to have surgery if it wasn't too risky. We didn't want to take the chance of having the infection/headache coming back all the way (at it's worst, it was so painful that I had to miss some final exams at school and I also went to the ER one night).

We discussed it with our ENT last week and he said that personally, he would try a more conservative approach if he were in my shoes (continued anti-biotics, more nasal irrigation, etc.) but that if we really wanted to, he would be fine with doing the surgery. In his opinion, the best option would be to continue more anti-biotics, etc. but surgery was still a good option. So at that appointment (July 15th), my ENT scheduled the surgery for July 27th and he also put be back on Biaxin. So I've been on Biaxin and been doing nasal irrigation for the past 7 days, and the headache has not subsided at all.

 
Old 07-24-2011, 04:40 AM   #4
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Re: Having ethmoidectomy and sphenoidectomy in a few days

Quote:
This time, my ENT put me on 500 mg of Biaxin (twice a day) for 3 weeks. In addition to that, I was taking Sudafed, Allegra, using a neti pot daily, and used a nasal spray for a few days. After about 3 weeks of that, I had felt fine and it was to the point where the only medicine I was taking was Allegra once a day (the doctor prescribed Allegra after a blood test confirmed that I had allergies and he thought that might have been the cause of the infection).
Have you done anything to manage the allergies? You should probably be on a nasal steroid spray and continue to use the Sudafed (during allergy season). It doesn't sound like your allergies are under control so the surgery may only provide temporary relief.

Quote:
We discussed it with our ENT last week and he said that personally, he would try a more conservative approach if he were in my shoes (continued anti-biotics, more nasal irrigation, etc.)
It sounds like your doctor gave you good advice, I think you should have listened to him and gone with the more conservative approach. Sinus surgery is serious surgery and, in your case, it's not going to address the underlying cause of the headaches, which sounds like allergies.

Quote:
So I've been on Biaxin and been doing nasal irrigation for the past 7 days, and the headache has not subsided at all.
It is likely that the headache is being caused by allergic inflammation, which in turn contributes to the infection, which in turn causes the infected areas to get more inflamed which creates a vicious cycle. The surgery will remove some tissue that will make the inflammation less problematic but, unless you address the underlying allergies with ongoing medical management (that will probably look a lot like what you did initially to get this under control), the surgery will only be a temporary fix.

Since you seem determined to go ahead with managing this surgically rather than medically, I would recommend you talk to your surgeon about the post-surgical follow up he provides - it can be as important as the actual procedure.

Last edited by gcsjr; 07-24-2011 at 04:41 AM.

 
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