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Medical Forum / Diseases and Disorders / Sinusitis / December 2004

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To FESS or not to FESS?

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Sue749 - 21 Dec 2004 12:04 GMT
Hi,
Last winter I got a very bad case of pneumonia, which was followed by
sinusitis.  Unfortunately the sinusitis wasn't diagnosed until it had
become chronic sinusitis.  I was treated for extended periods of time with
various antibiotics, which didn't help at all.  In addition to "regular"
sinus symptoms (headache, green discharge from the nose, etc) I continued
to have a bad cough, shortness of breath at times, and my GP could hear
noise in my lungs.  It was a pulmonologist who said that if I clear up the
sinusitis it will resolve the cough and problems with my lungs.

At the beginning of the summer I began prednisone, which did finally calm
things down.  In September I stopped the prednisone and remained only with
nasal steroid spray.  That has things under control, but I am not able to
stop it without all the symptoms returning.

My ENT says that I definitely "deserve" a FESS operation.  All of my
sinuses are blocked except for the frontals.  However, I haven't done it
yet because the ENT says there is only a 65% success rate in situations
like mine.  On the other hand, I don't like the idea of using the steroid
nasal spray endlessly.

What do you think?  Does anyone have any advice for me?  I would really
appreciate it.
Steven L. - 21 Dec 2004 15:46 GMT
> Hi,
> Last winter I got a very bad case of pneumonia, which was followed by
[quoted text clipped - 19 lines]
> What do you think?  Does anyone have any advice for me?  I would really
> appreciate it.

I think you should get a second opinion from another ENT.  Especially
since your case may be a more difficult one.

The magazine "U.S. News & World Report" does an annual survey to
identify the best hospitals in the U.S., in each of the major
departments--including otolaryngology. Go here:

http://www.usnews.com/usnews/health/hosptl/tophosp.htm

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Steven D. Litvintchouk
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Don Brady - 21 Dec 2004 21:39 GMT
>My ENT says that I definitely "deserve" a FESS operation.  All of my
>sinuses are blocked except for the frontals.  However, I haven't done it
[quoted text clipped - 4 lines]
>What do you think?  Does anyone have any advice for me?  I would really
>appreciate it.

First of all, there is nothing wrong with taking a steroidal sinus spray
indefinitely.  That is ok.   (Oral steroidss , on the other hand, are a
different situation).

I agree with Steven that you need some more opinions, preferably from a major
University medical center.   Do not think for a moment that, in a difficult
case,  all ENT's are equal.

The number 65% may be his way of saying that he is not sure at all of success.
I would want better odds if I could get them.
Steven L. - 23 Dec 2004 01:09 GMT
>>My ENT says that I definitely "deserve" a FESS operation.  All of my
>>sinuses are blocked except for the frontals.  However, I haven't done it
[quoted text clipped - 15 lines]
> The number 65% may be his way of saying that he is not sure at all of success.
> I would want better odds if I could get them.

65% is about par for the course.

The only scientific followup study on FESS, done by the Henry Ford
Hospital in Detroit, showed that the cure rate was around 75%.  So with
a more difficult case, 65% isn't at all out of the ordinary.

FESS is not a guaranteed cure for chronic sinusitis.

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Steven D. Litvintchouk
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Remove the NOSPAM before replying to me.

Sue749 - 23 Dec 2004 09:49 GMT
Thanks for your replies.

If the steroid nose spray has things under control should I continue with
this forever and just forget the surgery?  Is it something that can be
used long term?

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