Medical Forum / Diseases and Disorders / Sinusitis / August 2006
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?
 Signature Alison Chaiken "From:" address above is valid. (650) 236-2231 [daytime] http://www.wsrcc.com/alison/ Evolution whispers within us. It does not shout orders. -- L.A. Times 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 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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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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