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Medical Forum / Diseases and Disorders / Sinusitis / August 2006

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drainage ducts stenosis ?

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G@B - 04 Aug 2006 19:51 GMT
It is 4 months I'm irrigating.
I noticed that the situation didn't improve so I started to turn  my head
upside down
and increase gently the pressure to force the liquid into the sinuses.
With my surprise I felt the water in my frontal sinuses. I'm able to
shake my head and hear the liquid move as in a washing machine !
after a while I take the liquid out. I was able to clean the mucus which was
yellow.
My question is:
- can I be sure it is a drainage ducts stenosis now ?
I'm better but I still feel very heavy eyes all day long
- what else could I do ?

I'm already using betadine and drugs from my doctor.
Thanx
G@b
kathywb2001@yahoo.com - 05 Aug 2006 00:30 GMT
Just a guess, but if the saline is getting into the frontals, and you
are able to get it all out, then the ducts/and or openings aren't too
small.  Maybe they were blocked by the infection and you have worked it
loose.  ON the otherhand, if you are getting it up in there and it
isn't all coming back out, then that is very possible.  I think I had
been doing some of the later with my sphenoids, because sometimes after
irrigation, I felt worse, more pressure, pain, etc.

Kathyw

> It is 4 months I'm irrigating.
> I noticed that the situation didn't improve so I started to turn  my head
[quoted text clipped - 12 lines]
> Thanx
> G@b
G@B - 05 Aug 2006 08:10 GMT
I was thinking that your situation was similar Kathy.
I'm able to take out all the saline but I have to apply pressure that's
why I think the stenosis is not mild.
I have problems dealing with my doctor too because there are no
evidences in CT scans or endoscopy... how did you do ?

> Just a guess, but if the saline is getting into the frontals, and you
> are able to get it all out, then the ducts/and or openings aren't too
[quoted text clipped - 23 lines]
>> Thanx
>> G@b
Don Brady - 05 Aug 2006 16:55 GMT
>I was thinking that your situation was similar Kathy.
>I'm able to take out all the saline but I have to apply pressure that's
>why I think the stenosis is not mild.

I am sure you know but stenosis just means that the ostia (small sinus
openings) are narrowed or partly blocked..

This is extremely common after years of infections and allergies and
inflammation..

It is easy to open them up again surgically if they do not open up under
medical management.  You basically just cut open a larger opening.  It is not
the nost difficult of surgeries. Then you get a fresh start.

Some of the comments below are partly in response to another thread.

Once the ostia have been partly blocked for a long time, and if medical
mangement  does not open them, then it becomes less and likely that they will
open without surgery.

Really ENT's can often see that surgery is extremely likely to be required
eventually, but many current protocols and, sometimes more to the point,
insurance companies, do require that attempts to open them up medically be made
first.

Once they are opened up one way or the other, odds are good that the sinuses
will heal and improve.

So people need to start on medical management (steroid sprays etc.) or allergen
avoidance etc.  to either open them up, or if that does nip happen,  establish
the record that will justify surgery later on.....

If thay do stay partly blocked, often your sinuses will deteriorate and you may
require *much* more extensive surgery laer on..

Now, the above are all general comments and may or may not apply to a
particular situation.

Often when ENT's start to become distant and unresponsive, it is because they
can see what is needed (in their opinion) but you are insisting on following a
different course.  Often this happens when they want to do surgery and you do
not.  

I am not saying this is the case in your situation.

I do advise caution and trial of medical options and some delay and multiple
opinions before surgery.

But to call surgery a "last resort" is not exactly the right choice of words
for me.   One should leave it for a while, but not leave it too long either. It
is not all that risky for a healthy person, *if* done after choosing the best
surgeon after multiple opinions and careful research over a year or two.

On the other hand, I would not advise that anyone have surgery on the basis of
just one opinion.
Alison Chaiken - 05 Aug 2006 19:13 GMT
> I am sure you know but stenosis just means that the ostia (small
> sinus openings) are narrowed or partly blocked..  This is extremely
> common after years of infections and allergies and inflammation..

What blocks the ostia after years of inflammation?  Swelling?  Polyps?

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editorial, 05/10/06, via gtb

Don Brady - 05 Aug 2006 19:34 GMT
>> I am sure you know but stenosis just means that the ostia (small
>> sinus openings) are narrowed or partly blocked..  This is extremely
>> common after years of infections and allergies and inflammation..
>
>What blocks the ostia after years of inflammation?  Swelling?

Yes.  

Eventually it may not go down any more on its own except with surgery.   The
tissue becomes diseased and hardened.

> Polyps?

Sometimes but not always.  I never developed much in the way of polyps.
G@B - 05 Aug 2006 21:54 GMT
Thank you.
What substance could I add to the irrigation to open up the ostia ??
I was thinking capsaicin or eucalyptus but it could worse (if possible) the
situation

If someone is interested :
The situation is very different from the "classic" one you depicted:
I had surgery, I didn't want but two different doctors told me to
remove a cyst. It didn't help at all, it was in the left maxillary.
Now it's 5 years (or more) I have blocked sinuses. I hope they
could improve continuing with the cure...
I don't suffer from polyps nor from allergies.

I think that for the frontals there are no ostia but real drainage ducts and
surgery gets more complicated ... I should have stents implanted maybe ...
G@b

>>> I am sure you know but stenosis just means that the ostia (small
>>> sinus openings) are narrowed or partly blocked..  This is extremely
[quoted text clipped - 11 lines]
>
> Sometimes but not always.  I never developed much in the way of polyps.
Don Brady - 05 Aug 2006 22:25 GMT
>Thank you.
>What substance could I add to the irrigation to open up the ostia ??

I don't think you can other than steroids.  Soem people weill suggesst Xylitol
etc. but it is not too clear that it will help much.

If you eliminate inflammation in nearby areas then that should help.
kathywb2001@yahoo.com - 06 Aug 2006 03:45 GMT
I don't know if our problems are the same or not.  I didn't even know
that I had problems with my frontal sinuses, as they are very small.  I
thought it was all due to my ethmoids because most of my pain/pressure
has been behind my nose and eyes, with extreme pressure on top and
behind my head sometimes like a band (the sphenoids?).  There was bony
thickening in the ethmoids that was suggestive of osteitis, but Dr.
Sherris doesn't think that is a problem.   I have had a couple of CT
scans that have shown a small amount of fluid in the left frontal which
is the one that I think he said was the worst.  I don't know exactly
what he did to open them up, along with the sphenoids, but I know that
is all that he did, no removal of tissue, stents,  etc.   He did do a
biopsy and cultures, and there is still some question of allergic
fungal sinusitis.   But since I have had to be on prednisone to get my
sinuses to drain at all, it might mask the results.   I am supposed to
be getting the final report next week, because they are on vacation
this week.

I've been doing a little research on frontal sinusitis and it appears
that everyone is anatomically different in the way the frontal sinuses
drain, and since some of them drain into the ethmoids , then maybe that
is why my pain has been there.  You are right, there are ducts, but
also ostia, the opening into the ducts.

There is a good article about frontal sinusitis at:

  http://www.bcm.edu/oto/grand/110291.html

Here is a small excerpt:

"Fifty-five percent of frontal sinuses drain directly into the frontal
recess, 30% above the ethmoid infundibulum, 15% into the infundibulum,
and 1% above the ethmoid bulla. The frontal sinus, not present at
birth, develops from either the frontal recess or from anterior
ethmoidal cells. It is radiographically visible by seven years of age
and reaches full size by adulthood.
The etiology of frontal sinusitis stems from blockage of the
nasofrontal duct ostium. Mechanical obstruction and local mucosal edema
lead to symptoms of frontal headache, fever, rhinorrhea and cough."

I didn't have any complications from the surgery;  it was mild compared
to the pain that I was having.  It is probably too early to tell if
this is going to work.  I still have pain/pressure, but not quite as
bad.  There seems to be a more constant drainage most of the time now
instead of the buildup for several days, and then it all coming out at
once making me about strangle on it, so I'm trying to have hope that
this is going to work.  There is still some kind of
infection/inflammation? because I still have the nasty tasting drainage
(that was present before surgery).  It is gritty, like sand.

I would not consider surgery to be a last resort if you are talking
years instead of weeks and/or a few more months.  On the other hand, if
you can hold off a little longer and continue what you are doing, then
maybe you won't have to have surgery.  I did not know anything about
saline irrigation when my problems first started.  I have also found
xylitol to be somewhat useful in dissolving the mucus.

The real problem seems to be finding an ENT to take your symptoms
seriously, especially if not much shows up on the CT scans.  If you
have read my other posts, it has taken me years to get someone to do
so.

BTW,  have you been diagnosed with the frontal duct stenosis?   I would
guess that if that is the case, then you will most likely need surgery.
travmmann - 06 Aug 2006 05:02 GMT
You are SO RIGHT....getting an ENT to take one's symptoms seriously is VERY
difficult.Some of them are not interested in describing your history or
symptoms. This is why I fully type them up and give it to them so they HAVE
to read it!

Kindest personal regards,
Ray The Travellin' Man.....Ray Armstrong your eyes and ears on the Tweed!!
Let's Keep Music Liiiiiiiiiiiive!!!!!!!
> I don't know if our problems are the same or not.  I didn't even know
> that I had problems with my frontal sinuses, as they are very small.  I
[quoted text clipped - 59 lines]
> BTW,  have you been diagnosed with the frontal duct stenosis?   I would
> guess that if that is the case, then you will most likely need surgery.
Don Brady - 06 Aug 2006 06:11 GMT
I used to provide a long written history with detailed symptoms etc., with a
similar rationale,  but I found that a lot of them do not like it (a few
pretend to like it at least).

Some even really regard it as a "classic sign of neurosis."  This is not
entirely their fault, it used to be listed as such in textbooks.

So now I just try to practise effective verbal communication by highlighting a
couple of points per visit verbally and trying to get a good dialog going.  I
find that works better actually......

I would not discourage anyone from providing a well-organized and relatively
brief written history though.  I think that is very worthwhile....

>You are SO RIGHT....getting an ENT to take one's symptoms seriously is VERY
>difficult.Some of them are not interested in describing your history or
[quoted text clipped - 67 lines]
>> BTW,  have you been diagnosed with the frontal duct stenosis?   I would
>> guess that if that is the case, then you will most likely need surgery.
Steven L. - 06 Aug 2006 06:57 GMT
> I used to provide a long written history with detailed symptoms etc., with a
> similar rationale,  but I found that a lot of them do not like it (a few
> pretend to like it at least).
>
> Some even really regard it as a "classic sign of neurosis."  This is not
> entirely their fault, it used to be listed as such in textbooks.

In fact, Dr. Wilhelm Fleiss, a contemporary and friend of Sigmund Freud,
had developed this theory that neurotic symptoms could be caused by
stuffy noses!  He published papers on the "Nasal Reflex Neurosis," and
he used to perform turbinate reduction surgery on neurotic patients to
see if it would cure their neuroses.  Usually it didn't.

Still, I've often wondered if Dr. Fleiss may have been on to something
after all.  Lots of us sinus sufferers experience neurasthenic symptoms:
 depression, anxiety, difficulty sleeping, etc.--probably caused by the
chronic low-level infection.  And it's easy for those symptoms to be
misdiagnosed as stress or PMS--when it's really chronic sinusitis.

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Steven D. Litvintchouk
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Steven L. - 06 Aug 2006 06:54 GMT
>  I've been doing a little research on frontal sinusitis and it appears
> that everyone is anatomically different in the way the frontal sinuses
[quoted text clipped - 14 lines]
> ethmoidal cells. It is radiographically visible by seven years of age
> and reaches full size by adulthood.

The frontals don't always develop normally.  In my case, my left frontal
is much smaller than my right frontal.  And a good friend of mine had a
CT scan and discovered that she doesn't have a left frontal at all--it
never developed in her case.

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Shirley ann - 08 Aug 2006 10:11 GMT
I only have 1 frontal too. I had an xray of my sinus' that is how I
found out.  I was getting a lot of sinus infections then.

shirleyann
Steven L. - 06 Aug 2006 06:50 GMT
>>> I am sure you know but stenosis just means that the ostia (small
>>> sinus openings) are narrowed or partly blocked..  This is extremely
>>> common after years of infections and allergies and inflammation..
>> What blocks the ostia after years of inflammation?  Swelling?
>
> Yes.  

And a badly deviated septum can predispose the ostia on one side of the
head to block up before the ostia on the other side of the head.
Probably more with the ethmoid and maxillary ostia.

One way to distinguish sinusitis from allergy is asymmetry.  I always
had nasal stuffiness on the left side of my head only.  And my badly
deviated septum (it actually curved into a jog greater than 90 degrees)
was the likely culprit.

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Email:  sdlitvin@earthlinkNOSPAM.net
Remove the NOSPAM before replying to me.

travmmann - 05 Aug 2006 10:13 GMT
What type of irrigation system do you use?

Kindest personal regards,
Ray The Travellin' Man.....Ray Armstrong your eyes and ears on the Tweed!!
Let's Keep Music Liiiiiiiiiiiive!!!!!!!
> It is 4 months I'm irrigating.
> I noticed that the situation didn't improve so I started to turn  my head
[quoted text clipped - 12 lines]
> Thanx
> G@b
G@B - 06 Aug 2006 09:36 GMT
REcently I started to fill up all of my sinuses closing the nostrils
and gently increase and decrease the pressure in my lungs with
my head upside down.
This is not the method one should prefere. It's the only one I know
which allowed me to reach my frontal sinuses.
G@b

> What type of irrigation system do you use?
>
[quoted text clipped - 18 lines]
>> Thanx
>> G@b
 
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