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Medical Forum / Diseases and Disorders / Sinusitis / September 2007

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update on my sinusitis/headache problem:

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joe.rocket1@gmail.com - 26 Aug 2007 23:36 GMT
Thanks for all who replied previously. I am reposting here because the
discussion got "hijacked" into a discussion on obesity (No offense
intended, not saying it isn't an important issue, but it wasn't
relevant to sinusitis-headache). Here is the previous thread:
http://groups.google.com/group/alt.support.sinusitis/browse_thread/thread/094bef
6fe6da9da1/dd0168090c005ecb?hl=en#dd0168090c005ecb


FIRST POST
I've got what I think is a sinus problem, but I'm confused.
Some background: I do have allergies to pollens and dust. I once was
told there were alot of eosinophiles lining my nose. I live in the
Northeast and during the winters my nose dries out and there is often
blood in the mucus.

During the last winter, I had a series of left-side eye headaches
that
were painful, but they usually went away after a few days. However,
in
April I experienced a 3 day headache that seemed to start at the eye
and reach back to my left ear which felt congested. It seemed to
relent somewhat, but never went away. I saw my primary care phy who
said there was some nasal inflamation, but didn't do anything until I
suggested using a nasal cortisone inhaler (since May is my worst
allergy month). It helped prevent my allergies but didn't stop the
side headache.  I convinced my PCP to try a round of antibiotics
(Biaxin) which seemed to help some, but I had to quit after only 5
days as I was having severe side effects (aside from expected GI
problems, I had almost complete insomnia, anxiety attacks, heart
palpatations etc. -I will never take this drug again!!)
   I next made an appointment to see an ENT and had to wait 6 weeks.
Just saw the ENT who rushed me, but did the scope thing and just saw
a
deviated septum. Interestingly the scope seemed to directly of
indirectly bump into the area causing the pain (the ENT didn't seem
to
get this). The ENT said she could make no diagnosis until I get the
CT
scan (which will be in about 2 weeks).

My symptoms
Side headache/irritation, eye fullness, some obvious sinus pain
(that
seems to move a bit), the pain is affected by breathing thru the
nose,
have had blood in a nose pick (yes I've done that) with some pain,
it's affected by weather change and dryness, there is sometimes a
roten smell, I've had some irritation when holding a phone to my ear
for long conversations, I do not have green/yellow exudate, I don't
seem to have a fever

Can anyone please offer some advice/insight ???

NEXT POST
So here is my update.
I finally got the CT scan done. It shows a 21mm cyst in the left
maxillary sinus (should I be concerned?), but the ENT didn't think it
was causing symptoms. The sinuses are well aerated. There was only
little opacification of the sinuses (right ethmoid opacification).
There are some spurs and septum deviation. There is some indication
of
opacification on the right side and a agger nasi air cell. Bottom
line, she says not enough to account for the symptoms. She thinks
there may be some neuralgia and now wants me to have an MRI (checks
better for soft tissue lesions/growths pressing on nerves?). I'm not
fully in agreement with this since some symptoms seem sinus-specific,
but I will have it done anyhow.

I continue to have pressure and some left side pain around (esp
under)
the eye and at the side of the nose. I have a weird symptom that
sometimes TALKING seems to aggrevate the eye and side pain. I still
smell a rotten oder in  the left side. I have some pain/fullness on
the left side of my head close  to my ear. The ENT scoped again and
again bumped into an area that
seems to be related to the pain I feel, yet she saw nothing.

I briefly saw the allergist, but he thought that if the CT scan
didn't
show much, allergies shouldn't be involved. He thought I should see
an
opthamologist and he had a thyroid blood test done.

I'm still confused and minus a diagnosis. I intend to get the MRI
done.

MOST RECENT UPDATE:

I just finally got the results of my MRI. The MRI pretty much just
confirms my CT scan (maxillary cyst, deviated septum and now a small
lesion medial to the lamina papyracea (small blowout fracture?). (I
had a fall a couple of years ago and hit the left side of my face- my
eye was fairly bloody but seemed to be OK). There were no brain
lesions/growths especially noted around the trigeminal nerve (there
was a brain however- allthough it may be small). The ENT said the cyst
was common and not likely to be causing headaches//facial/eye pain but
offered to biopsy it (fairly difficult surgery) and straighten my
deviated septum. This, for now, seems like a low-percentage option.
She also gave me the name of an allergist. She suggested I see a
neurologist and she also said I could get a second ENT opinion. So
here are the options:

options:
1. Second ENT opinion
2. Neurologist
3. Cyst biopsy/removal septum straightening
4. Allergist
5. Opthamologist

I'm leaning towards getting a second opinion from an ENT that might
actually want to talk with me instead of rush me. To her credit Dr
Gray did order the appropriate tests. I did briefly see an allergist
(as I note above) who also didn't want to discuss things because the
CT scan was mostly negative -(nevermind that I live in an old dusty
house with forced hot air heating and a moldy basement and I have
known allergies to dust and mold.).
SO- any advice on my next step would be appreciated!
THANK YOU so much
vadanurag@gmail.com - 02 Sep 2007 06:41 GMT
On Aug 26, 5:36 pm, joe.rock...@gmail.com wrote:
> Thanks for all who replied previously. I am reposting here because the
> discussion got "hijacked" into a discussion on obesity (No offense
[quoted text clipped - 111 lines]
> SO- any advice on my next step would be appreciated!
> THANK YOU so much

Hi, bad to hear that you have to go thru so much and still not able to
figure
out what exactly is the problem. So, what I read from your post it
seems
like sinusitis to me for sure. I am suffering from it for many years
and it became
worse in the last couple of months. It was becoming diffiecult to
even
read, talk and concentrate at work at long . So my doctor, he was mad
at first that why did I wait so long. Anyway  put me on Flonase,ad
Cipro for
10 days and prescirbed CT scan, CT scan confirmed it is sinus the
frontol and
behind the cheeks . I just started taking Cipro again, plus Pednisone
and seeing
some improvement in the second day itself. I am on an intense dosage
of this
medication and have to take them for two weeks before I see my doctor
again.
I will keep you posted. And I hope that no one has to suffer from
this, it just
reduces ones ability to function and makes a small situation seems
like hell.
Good luck to you all
Anu
judy.n - 03 Sep 2007 13:01 GMT
Dr. Gray is at Mass Eye and Ear, right? The only thing I can relate is
that I had frontal pain for years, and did have a frontal mucocele,
but even after some fairly radical surgery, done at Mass Eye and Ear,
the frontal area still hurt. My ENT--local, not MEEI--always thought
it was referred pain due to a tight area up high due to a deviated
septum (although I'd had some septal surgery before.) He did a "small"
surgery to open up that area, and it made a big difference.
 The fact that she reproduced your pain when bumping into the spot on
your septum seems important to me.
 It's very frustrating when you are still suffering, but the
specialist has run out of therapeutic and/or diagnositic suggestions.
 Just another thought: often localized facial pain, "sinus headache"
is migraine. If you have nausea, light/sound sensitivity, consider
that possiblity.
 I still keep coming back to the fact that she could reproduce the
pain. My ENT talked about when that would happen, he would
specifically numb the area and see if there was relief, and kind of
"prove" that it was referred pain due to septal tightness.
 Just a thought.
 I hope you get some assistance soon.
Judy

On Sep 2, 1:41 am, vadanu...@gmail.com wrote:
> On Aug 26, 5:36 pm, joe.rock...@gmail.com wrote:
>
[quoted text clipped - 139 lines]
> Good luck to you all
> Anu
Johnny1000@webtv.net - 03 Sep 2007 15:49 GMT
>Just another thought: often localized facial
> pain, "sinus headache" is migraine. If you
> have nausea, light/sound sensitivity, consider
> that possiblity.

Over the years, I've had nausea and vomiting (many times) with a severe
headache situated beneath an eye brow. ...I thought at the time, it may
have been a migraine.  ...But one time, while experiencing these
symptoms, I lay on a cold compress for 10 minutes...  Irrigated and was
surprised to flush out masses of green mucus.   ...My headache and
nausea instantly disappeared. In my case, the symptoms were defintely
sinus related.  ..Jon
joe.rocket1@gmail.com - 05 Sep 2007 22:29 GMT
Thanks for your replies.

I have made an appointment to see a neurologist at Beth Israel in
about 3 weeks (don't know that much about him, but he supposedly deals
with headaches- I wasn't that impressed with his training but he's at
a reputible place). I tried to get an appointment at Mass General.
where they required alot of hoop jumping and it would be months to see
someone. I figure since migranes can cause some symptoms like mine and
since I have a MRI to show him, it's worth seeing a neurologist.
Depending on that consultation, I may also see a more-experienced ENT
for a second opinion.

Thank you.
judy.n - 06 Sep 2007 01:20 GMT
I once tried to get my daughter into the then migraine expert at Mass
General--Dr. Biondi, who has left clinical practice to work for
OrthoMcNeil (makers of topamax), and I had to jump through hoops, and
then the intake form came in the mail--very cursory, and the ground
rules for the visit--he would see her once, he would write no
prescriptions, and she would have to have a primary neurologist to
care for her some place else. I emailed him, and asked why he didn't
follow patients with the chronic condition of migraine, and he said
there were too few neurologists to go around. Ironically, considering
that migraine is very prevelant, there's a scarcity of migraine
experts in Boston. Dr. Elizabeth Loder was a great resource (Spaulding
Rehab), but she's limited her clinical work. A lot of New Englanders
with migraine travel to the Stamford Headache Clinic which is run by
the president of the American Headache Society, Fred Sheftell. I
belong to the NE Headachoe Cooperative, founded by Dr. Loder, but it
seems to be unraveling. I did go to their fall meeting last year.
 I have heard of a good neurologist in Worcester, and when I looked
him up, he reportedly specialized in Parkinsons, but he still managed
migraines well...
 Good luck.
Judy

On Sep 5, 5:29 pm, joe.rock...@gmail.com wrote:
> Thanks for your replies.
>
[quoted text clipped - 9 lines]
>
> Thank you.
judy.n - 06 Sep 2007 01:34 GMT
>From the site of the New England Headache Cooperative, here are their
fellowship sites, my recollection was that the neurologist in
Worcester is not the physician listed below, but someone who is
employed by U Mass, I could try and find his name, if you ever needed
it. FYI--here are the sites
Headache Clinic, Fletcher Allen Health Care, Burlington, VT
Robert E. Shapiro, MD, PhD, University of Vermont

New England Center for Headache, Stamford, CT
Fred Sheftell, MD, New York Medical College
Stewart J. Tepper, MD, Yale University School of Medicine

New England Institute for Behavioral Medicine, Stamford, CT
Randall E. Weeks, PhD
Steven M. Baskin, PhD

New England Regional Headache Center, Worcester, MA
Herbert Markley, MD, Univ. of Massachusetts Medical School

Headache and Pain Division, Brigham & Women's /Faulkner Hospital,
Boston, MA
Elizabeth W. Loder, MD, Harvard Medical School

Dartmouth Headache Clinic, Dartmouth-Hitchcock Medical Center,
Lebanon, NH
Thomas N. Ward, MD, Dartmouth Medical School
Morris Levin, MD, Dartmouth Medical School

The Headache Institute, St. Luke's Roosevelt Hospital, New York, NY
Larry Newman, MD, Albert Einstein College of Medicine

Boston University Pain Management Group, Boston, MA
Brian McGeeney, MD, Boston University School of Medicine
joe.rocket1@gmail.com - 06 Sep 2007 17:25 GMT
Judy - thank you for all your suggestions. I'll still give the Beth
Israel guy a shot first since it's such a rapid appointment and I feel
that I don't have that much to lose.

I'm also interested in your experience-- "always thought it was
referred pain due to a tight area up high due to a deviated
septum (although I'd had some septal surgery before.) He did a "small"
surgery to open up that area, and it made a big difference."

This sounds alot like what could be happening - my pain seems to
originate right below my left eye and right against the side of my
nose. If I get a second opinion from another ENT I will ask this.

Thanks
judy.n - 07 Sep 2007 02:37 GMT
No problem: what's making me nuts is that there is a better way to
phrase it than "a tight spot on the septum", and it's escaping me. I
know my ENT was convinced for a long time that my frontal/ethmoid pain
was referred from when the septum was rubbed by the other tissues, and
in the end, he was right. I do know that he wanted to specifically
numb the area and see if it made a difference.
 Good luck at the Beth Israel.
 Judy

On Sep 6, 12:25 pm, joe.rock...@gmail.com wrote:
> Judy - thank you for all your suggestions. I'll still give the Beth
> Israel guy a shot first since it's such a rapid appointment and I feel
[quoted text clipped - 10 lines]
>
> Thanks
 
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