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Medical Forum / Diseases and Disorders / Sinusitis / November 2006When to have surgery?
What is everyones opinion as to when to have surgery? Is it when your sick all of the time? My doctor told me that based on my CT that i need surgery, he claims based on the CT that i have infection in the ethmoids? I didn't know you could see infection on a CT only inflammation? Can you? On 11/5/06 5:27 PM, in article 1162776426.639783.227150@m73g2000cwd.googlegroups.com, "Lateralus" <mwgoldie67@cox.net> wrote: > What is everyones opinion as to when to have surgery? Is it when your > sick all of the time? My doctor told me that based on my CT that i need > surgery, he claims based on the CT that i have infection in the > ethmoids? I didn't know you could see infection on a CT only > inflammation? Can you? The indication for surgery is when you have a medical condition that is bothering you and it fails to respond to medcal treatment. We get patients all the time where the MRI showed sinus disease but the patient has no symptoms. No surgery. Similarly I see a deviated nasal septum that looks awfull, but he insists there are no symptoms - sleeps fine and no infection. No surgery. But an infected sinus with repeated bouts and has failed Rx and the sinus is anatomically blocked - surgery. A mucocele is simply a balloon with water. It can be asymptomatic - you leave it alone; or it can be symptomatic - pressing on the nerve, eroding the bone, etc. Statistically most are asymptomatic and if no symptoms or evidence of problems - no surgery. Very occasionally we can't decide if its mucocele or something else and recommend surgery to find out what it is. Occasionally the mucocele is huge and we don't want to risk it eroding into the nerve to the teeth. > On 11/5/06 5:27 PM, in article > 1162776426.639783.227150@m73g2000cwd.googlegroups.com, "Lateralus" [quoted text clipped - 25 lines] > Occasionally the mucocele is huge and we don't want to risk it eroding into > the nerve to the teeth. What type of symtoms would you base surgery on? Can you see infection on a CT scan or just inflammation. > What type of symtoms would you base surgery on? Can you see infection > on a CT scan or just inflammation. Good question. I've often wondered this myself. I know I've had infections that don't show up on CT scan. I hope that Dr. Grossan or someone else knowledgable answers this question. Does the CT scan just show mucosal thickening or will it show pus? What if the pus is white? Will that show? Good luck with your surgery. Kathyw >> What type of symtoms would you base surgery on? Can you see infection >> on a CT scan or just inflammation. [quoted text clipped - 4 lines] > show mucosal thickening or will it show pus? What if the pus is white? > Will that show? I've had experience with that. Yes, the CT scan can show fluid in the sinus--at least an experienced radiologist with good eyesight can pick it out though it's never been easy for me to see. In fact, I learned the hard way not to irrigate my sinuses before having a CT scan. I did that once and there was still a little saline solution in my sinuses. The CT scan detected it and the radiologist noticed it and wrote it in his report.  SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. On 11/6/06 5:33 AM, in article JQG3h.3033$L6.1424@newsread3.news.pas.earthlink.net, "Steven L." <sdlitvin@earthlinkNOSPAM.net> wrote: > In fact, I learned > the hard way not to irrigate my sinuses before having a CT scan. I did > that once and there was still a little saline solution in my sinuses. > The CT scan detected it and the radiologist noticed it and wrote it in > his report. Someone asked what is the evidence that pulsatile irrigation gets into the sinuses. See above. Rule is not to do pulsatile irrigation for 24 hours before a CT or other sinus X ray. > > What type of symtoms would you base surgery on? Can you see infection > > on a CT scan or just inflammation. [quoted text clipped - 8 lines] > > Kathyw What would white be an indication of??????? As a veteran of CT's I have found mucosal thickening and congestion in the sinuses both show on scans as grey areas, whereas clear healthy sinuses show black. > As a veteran of CT's I have found mucosal thickening and congestion in the > sinuses both show on scans as grey areas, whereas clear healthy sinuses > show black. Bone shows as white. And tooth fillings and crowns show as brilliant sunbursts. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > What is everyones opinion as to when to have surgery? Based on my experience, when either of the following occurs: 1. When two ENTs both suggest it 2. When three successive 3-week courses of powerful antibiotics have failed to produce any improvement (my famous "three strikes and you're out" rule), and you're still sick. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. >> What is everyones opinion as to when to have surgery? > [quoted text clipped - 5 lines] >failed to produce any improvement (my famous "three strikes and you're >out" rule), and you're still sick. Steven (and all), I agree with both, to a point, but I would add the following: 1. If the 2nd ENT is a treating physician, and not just a 2nd opinion for surgery. In my case, the 2nd ENT thought that the 1st ENT's recommendation for ethmoid surgery was "reasonable". It was only later when I used the 2nd ENT as my treating physician, and after his course of treatment, said I didn't have to have it. That's why I've said in posts many times to get an opinion on a second course of treatment, not just surgery. 2. Your rule works for you. For me, I figured, and from what I'd read, and my 2nd ENT agreed, that one month of Levaquin, along with a Medrol pak, and horse pill decongestant, then immediately followed by CT scan was the way to go. The differences in my first and second set of CT scans was night and day (or shadow and light, if you prefer.) With immunotherapy, I'm going into my 4th month of infection-free, non-surgical living and all the questioning and second-guessing my treatment is paying off. Rick "Bone shows as white. And tooth fillings and crowns show as brilliant sunbursts. " Old testament sins show up as dark purple...new testament ones as cyan... > > What is everyones opinion as to when to have surgery? > [quoted text clipped - 10 lines] > Email: sdlitvin@earthlinkNOSPAM.net > Remove the NOSPAM before replying to me. |
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