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Medical Forum / Diseases and Disorders / Sinusitis / September 2006CT Scan - does the finding have significance
I went to the ENT because I was having irritation in my sinuses for almost 2 months. A CT Scan was done with the following results: There is a mild mucosal thickening along the inferior aspect of both maxillary sinuses. There is mild mucosal thickening in the frontal sinuses inferiorly. There is minimal mucosal thickening along the anterior wall of the right sphenoid sinus. Impression: Overall minimal mucosal disease. My ENT says this is a normal result and is not indicative of any disease process. He recommends either allergy testing or referral to a neurologist (for possible migraine). Is his interpretation that mucosal thickening is a normal result consistent with others ? >I went to the ENT because I was having irritation in my sinuses for >almost 2 months. Can you give more details of the symptoms in layman's terms without referring to your sinuses directly? I do not know how to interpret "irritation in my sinuses." The sinuses are empty cavities in certain areas of the head. Do you mean irritation in your nose? > A CT Scan was done with the following results: > [quoted text clipped - 11 lines] >Is his interpretation that mucosal thickening is a normal result >consistent with others ? If it is mild it is not unusual. Did he look at the films themselves or just read the report? If he just read the report, I would see somene else because he is not hands-on enough. > >I went to the ENT because I was having irritation in my sinuses for > >almost 2 months. [quoted text clipped - 4 lines] > > Do you mean irritation in your nose? My main problem is that I feel pressure/irritation along the sides of my nose and under my eyes. The symptoms are fairly mild (not great pain) but highly annoying. > > A CT Scan was done with the following results: > > [quoted text clipped - 18 lines] > If he just read the report, I would see somene else because he is not hands-on > enough. On the follow-up visit he did look at the films as well as the report. >My main problem is that I feel pressure/irritation along the sides of >my nose and under my eyes. The symptoms are fairly mild (not great >pain) but highly annoying. Is this longstanding? Is it on both sdes? You might have a mild infection or just mild irritation as you say. It could also be referred pain from dental etc. > >My main problem is that I feel pressure/irritation along the sides of > >my nose and under my eyes. The symptoms are fairly mild (not great > >pain) but highly annoying. > > > Is this longstanding? Its been going on for almost 3 months now. > Is it on both sdes? Yes, it happens on both sides. > You might have a mild infection or just mild irritation as you say. > > It could also be referred pain from dental etc. When I first went to the doctor they treated me with antibiotics. The symptoms at that time were alot more intense, but after 3 weeks of 2 different antibiotics the symptoms didn't completely go away. They gave me predinisone for a week with no change. Finally, I got referred to the ENT. >> Is this longstanding? > [quoted text clipped - 10 lines] >When I first went to the doctor they treated me with antibiotics. The >symptoms at that time were alot more intense I suspect you had an acute infection then. Hopefully you will recover fully with time but steroid sprays (say Nasonex) may really be called for in your case for a few months. The point is not to relieve the irritation, which we assume is caused by the inflammation, but to cure the inflammation over time by making sure you have the best possible air flow into the sinuses while they are healing. So you will see no effect from the sprays but the goal is to make sure you recover over time. The goal is to be sure to avoid the onset of chronic sinusitis. >, but after 3 weeks of 2 >different antibiotics the symptoms didn't completely go away. They >gave me predinisone for a week with no change. Really! Predisone had no effect. That is extremely unusual I think. Something subtle may be going on but it probably just an indirect side effect of the prior infection in any case. >Finally, I got referred >to the ENT. I had symptoms along my nose and around my eyes: I had ethmoid disease and a frontal sinus mucocele, but my ENT was convinced that a lot of my symptoms were due to mucosa touching my septum when I got congested. I had a big surgery by someone else, a lot of complications, and a couple of years later he just removed some scar tissue and made the openning near my ethmoids a little wider--and I got a lot of relief. A lot of sinus pain is referred. However, tooth pain is usually maxillary sinus disease/infection. Judy > > >My main problem is that I feel pressure/irritation along the sides of > > >my nose and under my eyes. The symptoms are fairly mild (not great [quoted text clipped - 17 lines] > gave me predinisone for a week with no change. Finally, I got referred > to the ENT. >>> My main problem is that I feel pressure/irritation along the sides of >>> my nose and under my eyes. The symptoms are fairly mild (not great [quoted text clipped - 15 lines] > symptoms at that time were alot more intense, but after 3 weeks of 2 > different antibiotics the symptoms didn't completely go away. Ah, I didn't see this post before. It sounds like you had a major acute sinus infection, and that the bugs might have been resistant. If you've never had an acute sinus infection before, the antibiotic should have given you near-total relief after just 5 days--if the antibiotic was working properly. What antibiotics did you take? And how long did you take each one? There are fewer and fewer that work anymore, due to the increasing resistance of bacteria.  SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > >>> My main problem is that I feel pressure/irritation along the sides of > >>> my nose and under my eyes. The symptoms are fairly mild (not great [quoted text clipped - 24 lines] > > What antibiotics did you take? And how long did you take each one? The first antibiotic was Augmentin. I took that for 10 days. After that they gave me Bactrim. I took that for 10 days as well. > There are fewer and fewer that work anymore, due to the increasing > resistance of bacteria. [quoted text clipped - 3 lines] > Email: sdlitvin@earthlinkNOSPAM.net > Remove the NOSPAM before replying to me. >>>>> My main problem is that I feel pressure/irritation along the sides of >>>>> my nose and under my eyes. The symptoms are fairly mild (not great [quoted text clipped - 23 lines] > The first antibiotic was Augmentin. I took that for 10 days. After > that they gave me Bactrim. I took that for 10 days as well. Bactrim is a first-line antibiotic, often given when the patient is allergic to Augmentin. If the Augmentin didn't work, I doubt Bactrim would either. Before trying anything else, the right thing to do is try a "big gun" antibiotic like Levaquin or Avelox. And take it for a minimum of four weeks straight. Levaquin and Avelox have very wide coverage. They get the bugs the other antibiotics leave behind. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > >>>>> My main problem is that I feel pressure/irritation along the sides of > >>>>> my nose and under my eyes. The symptoms are fairly mild (not great [quoted text clipped - 34 lines] > Levaquin and Avelox have very wide coverage. They get the bugs the > other antibiotics leave behind. I like the advice, but how do I convince my doctor to prescribe this when he doesn't believe that there is any infection at all ? > -- > Steven D. Litvintchouk > Email: sdlitvin@earthlinkNOSPAM.net > Remove the NOSPAM before replying to me. >>>>>>> My main problem is that I feel pressure/irritation along the sides of >>>>>>> my nose and under my eyes. The symptoms are fairly mild (not great [quoted text clipped - 35 lines] > I like the advice, but how do I convince my doctor to prescribe this > when he doesn't believe that there is any infection at all ? You can tell him that you're thinking about surgery via balloon septoplasty, but you would like to try one more antibiotic first before taking such a drastic step. Doctors will usually try to work with their patients to avoid surgery if at all possible. If that ploy fails, then you may need to find another doctor. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. >>>>>>>> My main problem is that I feel pressure/irritation along the >>>>>>>> sides of [quoted text clipped - 42 lines] > You can tell him that you're thinking about surgery via balloon > septoplasty, Oops! I should have written, "balloon SINUPLASTY" SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > >>>>>>> My main problem is that I feel pressure/irritation along the sides of > >>>>>>> my nose and under my eyes. The symptoms are fairly mild (not great [quoted text clipped - 40 lines] > taking such a drastic step. Doctors will usually try to work with their > patients to avoid surgery if at all possible. Hmm. Certainly a novel approach. I made the appointment for late this afternoon. I plan on just telling him what's going on and asking him if he will prescribe an antibiotic to see if that will work. I'm not 100% convinced that I actually have an infection. When they were giving me antibiotics initially they also did a blood test which was normal. So, at the moment my game plan is to see if I can try one more antibiotic (I'll ask for Levaquin as you suggest) and then try allergy testing if that fails. > If that ploy fails, then you may need to find another doctor. > > -- > Steven D. Litvintchouk > Email: sdlitvin@earthlinkNOSPAM.net > Remove the NOSPAM before replying to me. >>>>>>>>> My main problem is that I feel pressure/irritation along the sides of >>>>>>>>> my nose and under my eyes. The symptoms are fairly mild (not great [quoted text clipped - 48 lines] > antibiotic (I'll ask for Levaquin as you suggest) and then try allergy > testing if that fails. Levaquin has some interesting drug interactions and side effects. http://www.rxlist.com/cgi/generic/levoflox_ad.htm http://www.rxlist.com/cgi/generic/levoflox_wcp.htm But if you can tolerate it (I tolerate it with no problems), it's probably the best drug for sinusitis. (Or Avelox, which is similar) SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. I had some realy bad side effects from Levaquin such as pounding heart and high blood pressure. I could even hear the pounding in my ears. I haven't had the same reactions with other quinolones such as Cipro and Avelox. Just an opinion, but Cipro might be a better first choice. It has more gram + coverage with some gram -. It is an older quinolone that has been used for cystic fibrosis and covers the most common gram - ones as well. . You're not as likely to have as many of the resistant gram - microbes if it hasn't become chronic and might want to save the "big guns" for later. I think this has already been said, but you need to make sure you don't have a certain heart arrythmia, I think called prolonged QT interval. I knew someone who had this and didn't know it, and almost died from it. It is relative rare though. There have been some people who have reported developing neuropathy on some of these. That may be in the links. Haven't had time to read them. I think for most people, they are realatively safe. Kathyw > Levaquin has some interesting drug interactions and side effects. > [quoted text clipped - 8 lines] > Email: sdlitvin@earthlinkNOSPAM.net > Remove the NOSPAM before replying to me. Kathy, Cipro was one of the first quinolones, and it's spectrum is mostly the gram negatives. The newer quinilones--levaquin, avelox, tequin--began to cover more gram positives as well. All quinilones can cause central nervous system side effects, prolong the QT interval--which is a problem both for people who hae a long QT or are on a lot of other medications that prolong the QT interval--like erythromycins, calcium channel blockers, tricyclic antidepressants. Recently tequin has gotten a lot of bad press for lowering/increasing blood sugar and now carries a warning it shouldn't be used for diabetics. I'll bet the other quinilones effect blood sugars as well. They all weaken tendons. Personally, I get "nuts" on levaquin--dizzy, can't sleep--but it works when nothing else does. It's my drug of last resort. I went to a lecture given by a consultant to NASA who reviews drugs for how they effect performance: and he said the quinolones make you dizzy and impair judgement. I've definitely seen older people, who are sick and in the hospital, get delirium when cipro is added to the mix (but they were at risk for it just because of how sick they were.) All the newer antibiotics that have come out in the last few years cover gram positives. Quinolones are the best gram negative coverage we have--for oral administration. (A nice thing about them is that the drug levels orally are as high as the levels IV.) Judy > I had some realy bad side effects from Levaquin such as pounding heart > and high blood pressure. I could even hear the pounding in my ears. I [quoted text clipped - 26 lines] > > Email: sdlitvin@earthlinkNOSPAM.net > > Remove the NOSPAM before replying to me. OK. I guess I was wrong. I just thought I had remembered reading that the newer ones had more gram negative coverage and that slightly decreased the gram positive coverage. At any rate, wouldn't it be better to choose a less powerful antibiotic as a first or even second line of treatment before resorting to the more powerful ones? I really don't know; I am just asking, because I'm now to the point of only being able to take the newer and more powerful ones. If we use these first, then what happens when we build up resistance to them? > Kathy, > Cipro was one of the first quinolones, and it's spectrum is mostly [quoted text clipped - 51 lines] > > > Email: sdlitvin@earthlinkNOSPAM.net > > > Remove the NOSPAM before replying to me. Kathy, I completely agree with you. At one point, I was so resistant, I could only take levaquin, and I was terrified that it would stop working--and then I'd have to go to IV's. The ENT literature says: first choice: high dose amoxicillin, more realistically a second generation cephalosporin or augmentin. If allergic, can use biaxin. Ketek is a possiblity, but there are lots of new safety concerns about it--cases of liver failure. The second choice, if you'd have moderate to severe disease, or have been on antibiotics in the last 6 weeks are Augmentin (and you can boost the amoxicillin dose by adding cheap amoxillin to the generic 875 mg Augmentin, or take the expensive Augmentin XR--it boosts the amoxicillin component to 4 grams of amoxicillin a day--and moderately resistant bugs can respond to higher blood levels) or a quinolone. There are other dual drug combinations: like clindamycin plus flagy. I tend to go by the "Sanford Guide" for infectious disease--they update it yearly, and the Academy of Otolaryngology will periodically issue guidelines. I completely agree that you want to take the first line drugs if possible, and leave other options open. I went to this Harvard lecture a couple of years ago about antibiotic resistance, and they were very alarmist, saying there are no new drugs in development for gram negatives--at that time. Judy > OK. I guess I was wrong. I just thought I had remembered reading that > the newer ones had more gram negative coverage and that slightly [quoted text clipped - 60 lines] > > > > Email: sdlitvin@earthlinkNOSPAM.net > > > > Remove the NOSPAM before replying to me. > OK. I guess I was wrong. I just thought I had remembered reading that > the newer ones had more gram negative coverage and that slightly > decreased the gram positive coverage. At any rate, wouldn't it be > better to choose a less powerful antibiotic as a first or even second > line of treatment before resorting to the more powerful ones? Absolutely. But the original poster said he had already been on two other antibiotics without success. And for me, after years and years of sinus infections, I'm stuck with quinolones as the last resort: I've been allergic to penicillin all my life, so I can't take amoxicillin. First, Bactrim (sulfa) stopped working on me. Then, Biaxin (macrolide) stopped working on me. Then, I became allergic to Ceftin (a cephalosporin). Doxycycline never worked on me. So for me, the quinolones are my last chance. In fact, it's made it tough for me to have surgery anymore, because not all hospitals stock IV quinolones or IV macrolides for surgical procedures. I can't take the usual IV cephalosporins (allergy). For my last sinus operation, they finally scrounged up some IV Cipro. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. How well did the cipro work for you? After using gentamicin sinus rinse for 2 weeks, then Avelox for 10 days, I still have the Klebseilla culturing out. I started cipro 2 days ago and added the gentamicin rinse back too. I'm wondering if being on Avelox and tequin several times in the past and Levaquin once (never again), if Cipro will even have a chance. The sensitivities show all of these having acceptably low MIC values, but nothing seems to be working. Since I had this cultured out before my last surgery without knowing it, and didn't find out until a couple of weeks later (even though it was also cultured at surgery), I'm afraid it's gotten out of control. I'm trying to function out of town with my mother in critical condition. My PC doctor says I may have to go back on IV antibiotics. That's why I try to caution about being careful with the over use of antibiotics without knowing what is being treated, and advise getting a culture when possible, but also knowing when you need to go to a stronger antibiotic. I think I was undertreated for years and with the ostia to the sphenoids and frontals blocked, the infections just "simmered" there and got worse and worse. Since this topic was originally on what CT scans show, I'm going to reapeat again what you and I and others have both said over and over (although a lot don't agree). They either do NOT show everything or the radiologist is not trained well enough to read them OR the ENT doesn't always take the time to look at the rarer problems such as the frontals and sphenoids, and an ethmoid infection doesn't always show up that well either. I was told numerous times that the ENT could could see all of my sinuses, the CT scans were fine, and all was well, even with running a fever and having most of the sinusitis symptoms including purulent drainage. In reality at the time of this last surgry, the right sphenoid was almost completely blocked, so there was no way they could see in there; same thing for the left frontal where the Klebsiella infection is. The first surgery was for the ethmoids which also was not showing up on CT scan. The maxillaries and main ositia are easiest to see endoscopically and also palpitate, so I think the others are often neglected So, getting the sinusitis treated properly before it becomes chronic is imperative. And that' s the big difficulty because there are so many things that cause it and just guessing at the right treatment can lead to disasterous consequences. For instance having surgery when allergies are the problem would be a big mistake, but trying to treat allergies when there is a blockage would be even a bigger one. It's been my experience from extensive research and reading stories, that some ENTS rush to do surgery when it isn't indicated (pays more) and others won't do surgery when it is needed. My advice would be to keep looking for an ENT to actually listen to ALL of the symptoms and THINK with the brain, not just the CT scan. I do think CT scans are usually the GOLD standard in most cases, but not always. Kathyw . For my > last sinus operation, they finally scrounged up some IV Cipro. > > -- > Steven D. Litvintchouk > Email: sdlitvin@earthlinkNOSPAM.net > Remove the NOSPAM before replying to me. > How well did the cipro work for you? After using gentamicin sinus > rinse for 2 weeks, then Avelox for 10 days, I still have the Klebseilla > culturing out. I wish I knew. My ENT told me that his lab doesn't culture for anaerobes, and that the cultures for aerobes all came back negative. I don't know where to go to get a full culture of what's up there. I do know that I continue to have this viscous discolored PND, a sure sign of a low-level infection, despite every antibiotic I have tried. If I could find an Infectious Disease Specialist who cared about any of this, I would ask about a course of Vancomycin. There are bugs like Enterococci that Vancomycin gets but the quinolones do not, and those bugs can exist in unsterilized water sometimes. > I started cipro 2 days ago and added the gentamicin > rinse back too. The Cleveland Clinic told me that they stopped prescribing gentamicin rinses after they discovered that enough gentamicin was getting into patients' bloodstreams to cause severe systemic effects in a few patients. That's why I won't try it anymore. (I did try Bactroban rinse but I couldn't tolerate it.) My ENT has also told me that there are no clinical studies proving the effectiveness of antibiotic rinses anyway. My best guess is that I still have a lingering pocket of infection somewhere, perhaps right in the bone of my skull. My ENT disagrees, so I'm stuck at this point. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > I wish I knew. > My ENT told me that his lab doesn't culture for anaerobes, and that the > cultures for aerobes all came back negative. Didn't you say at one time that you had coagulase negative staph cultured out several times? I know this has been discussed before, and most ENTS consider it to not be a true pathogen in sinusitis since it isn't as virulent as Staph aureus. Some labs report it and others do not. But there are more and more ENTS that are starting to reconsider. I actually have an email that I saved from Dr. Erica Thayer at UPenn who said that it was a true pathogen, and there are a few studies on Medline that indicate this, but I don't have the time or energy to find them now. This was the only thing that I had cultured out for years beside mold. There are some who are saying that the staph can produce superantigens that some people are allergic to. It is resistant to most antibiotics except vancomycin and a few others, so I think that is why most doctors won't treat it. > I don't know where to go to get a full culture of what's up there. I do > know that I continue to have this viscous discolored PND, a sure sign of > a low-level infection, despite every antibiotic I have tried. Do you think it is possible that you have a blockage in the sphenoids or frontals? If so, then if it isn't draining at the time of the culture, it won't show anything. That was my experience for a long time. At least since this last surgery to open mine up, it is draining a little more regularly and not backing up for days at a time. I would recommend sending scans and history to Dr. David Sherris in Buffalo, NY. He was at Mayo, Rochester for over 10 years and is also one of the pioneers in the eosinophilic fungal sinusitis theory, so you could get that addressed to. They test for MBP, but since I was on prednisone, he didn't do it. But he found out at least what part of my problem has been for many years just by looking at the scans and my medical records. He saw problems on the scans that other ENTS had not seen including the one I have now. I'm also using an itraconazole nasal rinse, but I'm not sure how well that is helping. There are too many other factors involved now to know for sure. > If I could find an Infectious Disease Specialist who cared about any of > this, I would ask about a course of Vancomycin. There are bugs like > Enterococci that Vancomycin gets but the quinolones do not, and those > bugs can exist in unsterilized water sometimes. I have only found one ID doctor who will even deal with sinusitis and he is in Atlanta. The last ID doctor I saw in my area (still 2 hours away) said I would just have to suffer the rest of my life. Sometimes, if you can find a good PC doctor, they will help. Zyvox (Linezolid) treats both staph and enterococci as well as other anaerobes and can be taken orally, but it is very expensive and can also have side effects. And then you run the risk of getting nasty gram - bacteria that it doesn't cover. I know endoscopic cultures are the most reliabe, but if you rinse out your sinuses with dilute hydrogen peroxide or betadine and wait for it to drain again and collect the mucus that comes out later in a sterile container, that sometimes eliminates the "normal" flora in the nasopharynx and you can get an accurate culture. That's how I found the Klebsiella and was fortunate enough to find a PC doctor to send it off and do sensitivities. > The Cleveland Clinic told me that they stopped prescribing gentamicin > rinses after they discovered that enough gentamicin was getting into > patients' bloodstreams to cause severe systemic effects in a few > patients. That's why I won't try it anymore. (I did try Bactroban > rinse but I couldn't tolerate it.) I know, I've read about that too, but I'm at the point that I'm suffering so much, I'll take the risk. I think maybe there has to be an open wound for it to be absorbed into the bloodstream. That's why I didn't use it right after surgery. If it doesn't help in a few days, I'll quit. I'm hoping it will work synergistically with the cipro. > My ENT has also told me that there are no clinical studies proving the > effectiveness of antibiotic rinses anyway. I do believe in the validity of clinical studies, but even when they are done, the results change all the time anyway. It would seem to me that if the bacteria is in the actual sinus cavity and not the tissue and it is susceptible to that antibiotic theoretically, it should work. But then there is the issue of biofilms that some bacteria produce and no antibiotic will penetrate (that's where xylitol can help) and some are intracellular, so a rinse wouldn't help there either. Then I have my doubts that the rinse would actually get into the frontals or sphenoids anyway. I know that has been recently discussed. I do remember several posters who got good results from the rinses and didn't have serious side effects. There can be serious side effects from any of the antibiotics in any given person. > My best guess is that I still have a lingering pocket of infection > somewhere, perhaps right in the bone of my skull. My ENT disagrees, so > I'm stuck at this point. Yes, I agree. My ENT said that small areas would not show on CT scan. It seems like there could be pockets of mini abscesses in the sinuses that aren't that accessible. I'm still not convinced that what is left of my ethmoid bones are not still involved, even though Dr. Kennedy reviewed my scans. They show areas of reactive bone formation and when I do a search it generally brings up osteomyelitis. As you can tell, this is all speculative on my part. But I do think that my overuse of antibiotics over the years without actually knowing what I was treating, along with the blocked sinuses has led to the more resistant infections I have now, and I have no other choice at this point. Although, I stress to not start out with the "big guns" like we are using, there is a point where more aggressive therapy is needed and I reached that point long ago after it was too late to keep it from becoming chronic. All they would give me back then was amoxacillin and it would go away and then come back in a few months. So, I'm not against using aggressive therapy if other measures have been tried first. Noone should let an infection simmer for months and years without it getting addressed whether it be antihistamines, allergy shots, antibiotics, antifungals, surgery, etc. Kathyw > -- > Steven D. Litvintchouk > Email: sdlitvin@earthlinkNOSPAM.net > Remove the NOSPAM before replying to me. >> I wish I knew. >> My ENT told me that his lab doesn't culture for anaerobes, and that the >> cultures for aerobes all came back negative. > > Didn't you say at one time that you had coagulase negative staph > cultured out several times? The only culture I ever had that found anything halfway significant was done by Dr. Wellington Tichenor in New York City. It was a nasal wash culture in which he injected fluid into my sinus cavities, aspirated it back out again and had it cultured. It cultured out Staph epidermydis and Enterococcus faecalis. I could never tell if these were true infections or just contaiminants--if you take warm sitz baths for congestion or hemorrhoids rather than showers, it's easy to get those bugs into your nose (guess why). But if they're true infections, then even quinolones are ineffective against Enterococcus faecalis. And since I'm allergic to the penicillins, I would be forced to take Vancomycin. >> I don't know where to go to get a full culture of what's up there. I do >> know that I continue to have this viscous discolored PND, a sure sign of >> a low-level infection, despite every antibiotic I have tried. > > Do you think it is possible that you have a blockage in the sphenoids > or frontals? I think it's more probable that I have a mild case of osteomyelitis. > I would recommend sending scans and history to Dr. David Sherris in > Buffalo, NY. He was at Mayo, Rochester for over 10 years and is also [quoted text clipped - 3 lines] > problem has been for many years just by looking at the scans and my > medical records. I saw an ENT at the Mayo Clinic a year ago, and he gave me the latest info on the eosinophilic fungal sinusitis (EFS) theory. Mayo has backed off from the idea that it's the cause of 95% of chronic sinusitis. They now say it's only a subpopulation of sinus patients who show certain symptoms of inflammation via endoscopy that are likely sufferers of EFS. And I wasn't one of those. Sure, I can try a Sporonox nasal rinse; Mayo even offered to give me a scrip. But lacking a definitive diagnosis, I'm tired of just shooting meds into my body just to see what would happen. So far, that shotgun approach has given me plenty of side effects and allergic reactions but no real cures. But I'll contact this Dr. Sherris and see what he says. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > It cultured out Staph epidermydis and Enterococcus faecalis. I could > never tell if these were true infections or just contaiminants-- Staph epidermidis is the most common coagulase negative staph and it can cause osteomyelitis. But like you said, it is hard to tell if it is a contaminant. It is very common on the skin so can be very easy to get into the nose and I guess eventually the sinuses. My grand daughter got an infection in her spine with it after having mono and running a high fever. Luckily it responded to IV cephalosporins and then oral ones. It can cause endocarditis and a host of other infections, but still most ENTs do not consider it a pathogen in sinusitis. My grand daughter has had sinus problems ever since then. > But if they're true infections, then even quinolones are ineffective > against Enterococcus faecalis. And since I'm allergic to the > penicillins, I would be forced to take Vancomycin. If you look up E faecalis and zyvox (linezolid), you will find that it is supposed to respond to it also although there are some resistant strains now.. But then again, when you use these you run into the problem of getting more resistant gram - bacteria so it can be a viscious cycle. > I think it's more probable that I have a mild case of osteomyelitis. Do you have pain with it? Have you ever had a nuclear bone scan? >From what I understand they only show up infection in the sinus bones 50% of the time > I saw an ENT at the Mayo Clinic a year ago, and he gave me the latest > info on the eosinophilic fungal sinusitis (EFS) theory. Mayo has backed > off from the idea that it's the cause of 95% of chronic sinusitis. They > now say it's only a subpopulation of sinus patients who show certain > symptoms of inflammation via endoscopy that are likely sufferers of EFS. > And I wasn't one of those. Yeh. I'm somewhat skeptical about it too, although I do think mold is a major factor in my case. There are some other theories out about it too such as the production of proteases that damage the mucus membranes. But I do agree that it is not as big a factor as Mayo has made it out to be. So, what did they say at Mayo. Could they give you an explanation for why you continue to have the purulent drainage? > Sure, I can try a Sporonox nasal rinse; Mayo even offered to give me a > scrip. But lacking a definitive diagnosis, I'm tired of just shooting > meds into my body just to see what would happen. So far, that shotgun > approach has given me plenty of side effects and allergic reactions but > no real cures. I had a lot of problems with the amphotericin wash. I think it made the membranes swell so I may have been allergic to it. I haven't had the problem with the sporonox rinse, but like I said, I'm not convinced that it helps. I've taken oral sporanox and it has seemed to help somewhat. I've gotten out all kinds of debris that looks like fungal filaments when using it and VFend. I don't like to use them for long periods of time because of the possibility of liver damage. But I did receive an email from Dr. Kita, who is also doing reserach at Mayo and they are going to start clinical trials of the oral sporanox. > But I'll contact this Dr. Sherris and see what he says. It wouldn't hurt. You can send scans and medical records, etc. and he will write a full report for $250.00. That's not much more than an office visit. I was very skeptical at first, but during the surgery, he found exactly what he had diagnosed from looking at the scans. I just can't get rid of this latest infection (actually the one I had before surgery). It seems impossible to find one person to consider all aspects and treat them at the same time. Kathyw > >>>>>>>>> My main problem is that I feel pressure/irritation along the sides of > >>>>>>>>> my nose and under my eyes. The symptoms are fairly mild (not great [quoted text clipped - 56 lines] > But if you can tolerate it (I tolerate it with no problems), it's > probably the best drug for sinusitis. (Or Avelox, which is similar) My Drs advice was to pursue the allergy route. One basis for this was that the blood test showed a fairly high total Ige level (I think 120) which he says could indicate allergic sensitivity, although, from my reading it seems this isn't that reliable a measure. He gave me nasonex and also astelin to try. I go in for skin testing next week. > -- > Steven D. Litvintchouk > Email: sdlitvin@earthlinkNOSPAM.net > Remove the NOSPAM before replying to me. I thought 120 IgE was suggestive of allergy, but not definitive. Actually, I have allergies clinically and lots of positive skin tests, and my IgE levels are always low. Allergy shots have helped me a lot. Judy > > >>>>>>>>> My main problem is that I feel pressure/irritation along the sides of > > >>>>>>>>> my nose and under my eyes. The symptoms are fairly mild (not great [quoted text clipped - 67 lines] > > Email: sdlitvin@earthlinkNOSPAM.net > > Remove the NOSPAM before replying to me. > I thought 120 IgE was suggestive of allergy, but not definitive. > Actually, I have allergies clinically and lots of positive skin tests, > and my IgE levels are always low. I have done a little bit of research on this now. It seems to me that high levels of IgE are suggestive of allergy, but this only correlates to a 50-60% clinical finding of allergy overall. Also quite clear is the case where IgE is low or normal and allergies can be found clinically. So, I guess what this amounts to is that total IgE has both a high false positive and a high false negative rate. > Allergy shots have helped me a lot. > Judy [quoted text clipped - 70 lines] > > > Email: sdlitvin@earthlinkNOSPAM.net > > > Remove the NOSPAM before replying to me. > I went to the ENT because I was having irritation in my sinuses for > almost 2 months. A CT Scan was done with the following results: [quoted text clipped - 12 lines] > Is his interpretation that mucosal thickening is a normal result > consistent with others ? At the risk of sounding Clintonesque, it all depends on what your definition of "normal" is. With all the allergens, pollutants, and other insults to our respiratory system we have to deal with these days, some mild inflammation of the respiratory system could be thought of as "normal" these days, yes. Did your physician prescribe steroids to try to knock down that inflammation? Topical steroid nasal sprays can work in mild cases. Have you investigated environmental causes? Is the air polluted where you live and work? SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > > I went to the ENT because I was having irritation in my sinuses for > > almost 2 months. A CT Scan was done with the following results: [quoted text clipped - 22 lines] > Did your physician prescribe steroids to try to knock down that > inflammation? Topical steroid nasal sprays can work in mild cases. Before referral to the ENT by my family doctor I was prescribed flonase. However, it doesn't seem to help. > Have you investigated environmental causes? Is the air polluted where > you live and work? Our air pollution is relatively low compared to other urban areas. So far, I haven't been able to identify anything in the environment that would be causing this. > -- > Steven D. Litvintchouk > Email: sdlitvin@earthlinkNOSPAM.net > Remove the NOSPAM before replying to me. CT scans are only part of an overall picture. They can be "normal" or minimally abnormal with patients who have significant clinical disease, or they can show the kind of non-specific mucosal thickening that your's did, with patients who have no symptoms. I completely agree that the ENT HAS to view the films: all the really good ENT's I know tell me this. The reports just don't tell them what they need to know. The report didn't address the patency of the ostea--are the opennings of the sinuses able to drain? or are they blocked by various obstuctions? There have been previous posts about patients with normal CT's, recurrent infections, and biopsies at surgery showed extensive disease. CT's are helpful, but can have both false positives and negative results and need to be interpreted with the patient's symptoms. Judy > > > I went to the ENT because I was having irritation in my sinuses for > > > almost 2 months. A CT Scan was done with the following results: [quoted text clipped - 37 lines] > > Email: sdlitvin@earthlinkNOSPAM.net > > Remove the NOSPAM before replying to me. > CT scans are only part of an overall picture. They can be "normal" or > minimally abnormal with patients who have significant clinical disease, [quoted text clipped - 6 lines] > of the sinuses able to drain? or are they blocked by various > obstuctions? We did look together at the scan on the follow up. He pointed out that there was no blockage, no notable septum deviation. The only other thing that the scan showed was a small mucous retention cyst on the floor of one maxillary sinus. However, this was truly tiny, not blocking anything, etc. My sister has had chronic sinusitis for about a decade with "negative" CT scans. She did find an ENT at Kaiser who agreed to operate and do minimal functional endoscopic surgery, While she's not cured, she's better. I think it all depends on your symptoms: unremitting sinus infections vs. congestion. If not constantly infected, you can pursue irrigation, allergy treatment, astelin, etc. Judy > > CT scans are only part of an overall picture. They can be "normal" or > > minimally abnormal with patients who have significant clinical disease, [quoted text clipped - 12 lines] > floor of one maxillary sinus. However, this was truly tiny, not > blocking anything, etc. > We did look together at the scan on the follow up. He pointed out that > there was no blockage, no notable septum deviation. The only other > thing that the scan showed was a small mucous retention cyst on the > floor of one maxillary sinus. However, this was truly tiny, not > blocking anything, etc. You say you've been having this irritation in your sinuses for nearly 2 months. Can you think of any changes in your lifestyle or environment that may have triggered it? Did you have a bad cold or something at the time? Or did you just start to notice this irritation one day out of nowhere? If it started that recently, can you remember anything that might have happened around that time to trigger it? SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > > We did look together at the scan on the follow up. He pointed out that > > there was no blockage, no notable septum deviation. The only other [quoted text clipped - 10 lines] > If it started that recently, can you remember anything that might have > happened around that time to trigger it? I didn't have a cold or anything at the time. It started as just a tingling along my nose and around my eyes. At first I attributed it to fatigue because it started the evening when I had returned from getting stiches at the emergency room for a cut on my finger. I can't think of anything environmental that has changed at home or at work. The irritation is usually not so bad in the morning and then gets progressively worse as the day goes on. > -- > Steven D. Litvintchouk > Email: sdlitvin@earthlinkNOSPAM.net > Remove the NOSPAM before replying to me. |
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