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Medical Forum / Diseases and Disorders / Sinusitis / May 2006I think I may need surgery - advise needed
Hi, I am been battling constant inflammation of my nasal passages for 5 months with no respite. I feel "constant" ear fullness and stuffy nose. I think my turbinates have become so swollen that nothing brings them down. Everytime I encounter an irritant, my turbinates swell. Inside or outside, it doesn't seem to make a difference. I feel some pain on the right inside of my nasal area which an ENT says is due to swollen turbinates. I feel that the inside of my right nasal passage is constantly swollen. I think that my chronic exposure to dust-mites and dust (which I am allergic to) over the years has permanently damaged or inflamed my turbinates. In recent months, I have undertaken all the measures to control dust in my home and bed with no relief. I have lots of white mucous and my right nasal passage has constant PND. Sometimes the inflammation inside gets so bad that I feel like air just passes straight to my lungs. This is especially the case during and after exercise resulting in shortness of breathe. This is just not normal. My right nasal passages does not feel normal. There is tightness and congestion that goes all the way to my ears. I have been using Rhinocort Aqueous spray for 3 months and it does not help. I have tried irrigating with the Neilmed rinse and Grossan Hydropulse but they seem to make the inflammation worse. I can feel pain in my right side when irrigating which I have never read happening to people. After irrigation, I can smell a lingering odor which I think is the bacterial rot inside which is not draining. I don't get residual drainage 20 or so minutes after which means that the inflammation is very bad. I have heard so many good things about irrigation. Unfortunately, I feel that it just inflames my turbinates even further. Regarding surgery, is it better to have a somnoplasty by radio-frequency, a laser cautery or a sub-mucous reduction of my turbinates. I have read about empty-nose and dry-nose syndrome so I wish to preserve as much of my mucousal-lining and cilia as possible. The ENT surgeons here in Australia don't seem to have much sinus surgery experience. Anyone know of good experienced sinus surgeons in Sydney, Australia? Thanks, Chris > Hi, > [quoted text clipped - 11 lines] > undertaken all the measures to control dust in my home and bed with no > relief. Have you had a sinus CT scan and nasal endoscopy? If so, what did these tests show?  SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. >> Hi, >> [quoted text clipped - 14 lines] > Have you had a sinus CT scan and nasal endoscopy? If so, what did these > tests show? Also allergy testing? and allergy shots? If you have known allergies, surgery won't help much until you get the allergies under control. Have you tried a short course of strong oral steroids to get the inflammation down enough so that a nasal steroid will be helpful? AW Had the sinus CT scan 30 minutes after the nasal endoscopy with anaesthetic about 3 months ago. Most probably missed my hyper-swollen internal turbinates. Otherwise, CT scan showed no sinusitus. I have had allergy testing. Very allergic to dust mites, house-dust, cats (I have no cats), cockroaches. Have done just about everything I can to control dust in my home. Even when outside, my turbinates get irritated and swell for no reason. I may have been too hasty with the surgery call but I'm just tired of feeling like this everyday. I will give the allergy desensitization a go. It's just so slow to get anything done down here in Australia. I have consulted with two allergiests. One recommends oral drops while the other allergy shots so I need some help deciding which route to take. Allergist #1 recommends oral drops which I take for 12-13 weeks along with a food allergy elimination diet. He says allergy shots are not entirely safe. I can started in a week. Allergist #2 told me food does not play a role and that Allergist #1 too alternative and a bit suspect in his methods. Allergist #2 wants me to go on allergy shots but I need another month before he comes back from overseas to get started. Any pointers as to which one I should go for? >Had the sinus CT scan 30 minutes after the nasal endoscopy with >anaesthetic about 3 months ago. Most probably missed my hyper-swollen [quoted text clipped - 4 lines] >can to control dust in my home. Even when outside, my turbinates get >irritated and swell for no reason. Well there is mould and pollen in the air outside.. >I may have been too hasty with the surgery call but I'm just tired of >feeling like this everyday. I will give the allergy desensitization a [quoted text clipped - 6 lines] >with a food allergy elimination diet. He says allergy shots are not >entirely safe. They are safe enough. >I can started in a week. >Allergist #2 told me food does not play a role and that Allergist #1 >too alternative and a bit suspect in his methods. I agree with #2. Food can be a factor in nasal allergy, but far more common is airborne allergens. > Allergist #2 wants me >to go on allergy shots but I need another month before he comes back >from overseas to get started. >Any pointers as to which one I should go for? #2. #1 sounds to me like an "alternative practitioner." Does he have credentials at all? On 5/24/06 6:49 PM, in article 1148521760.755472.22730@i39g2000cwa.googlegroups.com, "chrisw" <sanufi@gmail.com> wrote: > Had the sinus CT scan 30 minutes after the nasal endoscopy with > anaesthetic about 3 months ago. Most probably missed my hyper-swollen [quoted text clipped - 20 lines] > from overseas to get started. > Any pointers as to which one I should go for? I wonder if what you have are true hypertrophy of the turbinates? Here the tissue has swollen out of shape and vasoconstriction - afrin, etc - can no longer shrink them . If so, since the tissue won't shrink, might as well get a procedure where the turbinates are shrunk and that takes care of the problem. Several methods Submucus resection of the turbinate Somnoplasty or similar proceduce There are other methods, depending on the ENT doctor. Warning: I am a surgeon and not an allergist so of course .... Hypertrophy of the turbinates? Sounds scary. Dr Grossan, how many cases have you seen of this? Is surgery successful for these cases? How does one diagnose this condition? I find that the shower usually relieves the swelling. On 5/25/06 3:38 AM, in article 1148553480.209802.193640@i39g2000cwa.googlegroups.com, "chrisw" <sanufi@gmail.com> wrote: > Hypertrophy of the turbinates? Sounds scary. Dr Grossan, how many cases > have you seen of this? Is surgery successful for these cases? > > How does one diagnose this condition? I find that the shower usually > relieves the swelling. Really it is quite simple. The turbinates are swollen and block the brathing and fail to respond to normal medication. The person's I see usuallly have failed to shrink despite allergy desensitization. Its like any tissue - lower eyelids, obese skin, etc that is permanently swollen out of shape. If you are sure that the allergy desensitization won't restore the turbinate, then SMR of turbinate or somnoplasty type procedure is available. >Hi, > [quoted text clipped - 32 lines] >radio-frequency, a laser cautery or a sub-mucous reduction of my >turbinates. The last in most cases. Evens till it needs to be done by a skilled surgeon. > I have read about empty-nose and dry-nose syndrome so I >wish to preserve as much of my mucousal-lining and cilia as possible. >The ENT surgeons here in Australia don't seem to have much sinus >surgery experience. Anyone know of good experienced sinus surgeons in >Sydney, Australia? They must be there. Try researching the astaff at whichever teaching hospital has the most expertise in that area. Surgery might help but you need to do it only after two or three expert opinions recommend it. Allergist #1 was a former ENT but is no longer practicing. He suggested sub-mucous reduction SMR (is this the same as a sub-mucous resection?) as a quick-fix. He does, however, believe that oral drops plus food allergy elimination diet will solve my problems. But since he is no longer an ENT, well who knows. >Allergist #1 was a former ENT but is no longer practicing. You may want to check if he resigned his former surgery practice (if any) at the time of an investigation or similar untoward circumstances. I am not saying that is likely. It is just something to check into whenever you come across a doctor who is no longer practicing in a field of surgery. >He suggested >sub-mucous reduction SMR (is this the same as a sub-mucous resection?) Yes it is the same. It is not just a quick fix, it would be a very normal procedure, as Dr. Grossan mentions. But it needs to be done with care. >as a quick-fix. He does, however, believe that oral drops plus food >allergy elimination diet will solve my problems. Well there's little harm in trying I guess but I personally doubt that the food allergy hypothesis is that likely in yur case. It can be on occasion though.... >But since he is no >longer an ENT, well who knows. > Allergist #1 was a former ENT but is no longer practicing. He suggested > sub-mucous reduction SMR (is this the same as a sub-mucous resection?) > as a quick-fix. He does, however, believe that oral drops plus food > allergy elimination diet will solve my problems. But since he is no > longer an ENT, well who knows. I've tried both drops with the elimination diet and allergy shots (from different Drs). The shots are much more effective IMO. Nothing in life is totally safe but allergy shots aren't high on my list of worries. My ENT Dr does write you an RX for an epinephrine pen, but I've never had any bad reaction other than a bit of swelling at the injection site. The shots are a significant investment in time and money but for me were worth it. AW
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