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Medical Forum / Diseases and Disorders / Sinusitis / June 2008Results of my sinus CT scan
Findings CLINICAL HISTORY: Sinusitis Technique contiguous coronal scans of the sinuses are produced using the multidetected CT scanner, without contrast administration. The sinuses are well pneumatized, without evidence of mass lesion, air-fluid level significant mucoperiosteal thickening. No destructive lesion is present. The nasal septum is slightly deviated to the left of the spetal spur. The orbital and visualized intracranial structures are unremarkable. IMPRESSION: Normal CT scan of the sinuses. And my sinuses are still swollen, especially the left one. Along with diziness, and lightheadedness. I'm going to see my ENT on Tuesday. Michelle > Findings > [quoted text clipped - 11 lines] > > IMPRESSION: Normal CT scan of the sinuses. Is this from the radiologist's report? Never go by what the radiologist found. Take the CT scan films to your ENT and have him review them--with you standing there.  SignatureSteven L. Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > Is this from the radiologist's report? > [quoted text clipped - 7 lines] > > - Show quoted text - Sorry if this gets posted wrong. My ISP closed the newsgroup server, so now I'll have to use Google. That was a radiology report. I went to see my ENT Tuesday, and he told me that my CT looked fine, and I didn't have sinusitis. But he did look into my sinuses and told me that they were chronically inflamed, and that I should consider surgery. He wants to try a steroid spray (Nasonex) first, to see if this will help, so I have an appointment to see him again in 2 months. Is there a better allergy pill than Zyrtec?? I want to take something that doesn't make me sleepy during that day. Thanks, Michelle >>Is this from the radiologist's report? >> [quoted text clipped - 24 lines] > > Michelle Take it to more ENTs. The radiologist and the ENT who viewed my 2/07 C-T said it was fine, the new ENT had the screen MUCH brighter and found severely infected sinuses, one with no opening on the same scan. Susan >> Is this from the radiologist's report? >> [quoted text clipped - 15 lines] > look into my sinuses and told me that they were chronically inflamed, > and that I should consider surgery. This raises a red flag with me. I had an ENT who said the same thing about my CT scan--based on that, I didn't have sinusitis. As a result, I suffered for years until I found another ENT who diagnosed me with sinusitis properly. He relied on his judgment, experience, and a very detailed patient history he took of me, rather than on the CT scan alone. I think you should get a second opinion from another ENT. And this time, find one who is aware that the CT scan isn't Holy Writ--CT scans do have a small percentage of false negatives, like any other medical test. SignatureSteven L. Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > This raises a red flag with me. > [quoted text clipped - 7 lines] > time, find one who is aware that the CT scan isn't Holy Writ--CT scans > do have a small percentage of false negatives, like any other medical test. I had to kiss 6 ENT frogs before finding one recently who saw flaming infections in 6 of my sinuses on a C-T scan the last rad and ENT called normal and even "beautiful." For years, my passages were described as severely inflamed, and my report of gross discharge ignored due to such incompetence and dismissiveness, and the suffering has been just awful. According to a review study, C-T scans have very poor concordance with actual chronic sinusitis symptoms. Steven, did you request and get the paper about this I offered after I paid for it? Susan > x-no-archive: yes > [quoted text clipped - 14 lines] > infections in 6 of my sinuses on a C-T scan the last rad and ENT called > normal and even "beautiful." I think that part of the problem, is that medical schools traditionally taught that true chronic sinusitis was an unusual (though not rare) condition. That most patients who present with "sinus problems" really just have rhinitis, possibly of the non-allergic type. And that even when one caught a common cold, it didn't usually involve secondary infection of the sinuses. So ENTs are not predisposed to consider little abnormalities here or there on a CT scan as "sinusitis," but as something else. Modern ENTs have learned the hard way that this story--Sinusitis 101 as it used to be taught in medical school--is total, complete, bunk. In fact, when you get a common cold, the sinuses are *routinely* infected too--so much so that it's appropriate to call a cold "viral rhinosinusitis". > For years, my passages were described as severely inflamed, and my > report of gross discharge ignored due to such incompetence and [quoted text clipped - 3 lines] > actual chronic sinusitis symptoms. Steven, did you request and get the > paper about this I offered after I paid for it? Huh? I do not recall you asking me to get any such paper. Maybe I hadn't read your post to that effect. SignatureSteven L. Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > I think that part of the problem, is that medical schools traditionally > taught that true chronic sinusitis was an unusual (though not rare) [quoted text clipped - 10 lines] > too--so much so that it's appropriate to call a cold "viral > rhinosinusitis". The last ENT who blew me off with the scan that was so awful was in his 30s at most. The new one is 58. The problem was that the young one had a very dark screen on his laptop and the older one had it lit up much brighter. I think it's too often that effing simple and stupid. The difference was striking and the same scan showed everything plain as day when lit properly. >> For years, my passages were described as severely inflamed, and my >> report of gross discharge ignored due to such incompetence and [quoted text clipped - 6 lines] > Huh? I do not recall you asking me to get any such paper. Maybe I > hadn't read your post to that effect. It was long ago, only Elizabeth asked for it. Would you like it? Susan > x-no-archive: yes > [quoted text clipped - 19 lines] > difference was striking and the same scan showed everything plain as day > when lit properly. Not in my case. My ENTs all had the same original photographic films (no artifacts from any computer screen). They just interpreted them differently. The ENT who agreed to operate on me, did so *despite* his not finding anything too bad on the CT scan. He made his decision after taking a long, long patient history from me, extensive questioning of my symptoms and history, etc., and interpreting the CT scan in that context. Whereas the first two ENTs I saw took only a perfunctory history of me, and based their diagnosis entirely on the CT scan--which wasn't sufficiently conclusive. That was the problem. Hippocrates taught the importance of a detailed patient history and intensive observation of the patient's symptoms. After CT scans and MRI scans and all the other high-tech tests have come and gone, the detailed patient history and observation of the patient's symptoms are still the best diagnostic tool, even today. >>> According to a review study, C-T scans have very poor concordance >>> with actual chronic sinusitis symptoms. Steven, did you request and [quoted text clipped - 4 lines] > > It was long ago, only Elizabeth asked for it. Would you like it? Could you just summarize the abstract for me? SignatureSteven L. Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > Not in my case. > [quoted text clipped - 8 lines] > and based their diagnosis entirely on the CT scan--which wasn't > sufficiently conclusive. That was the problem. My new ENT said he ignores the C-T if the patient has symptoms, as I said earlier; "you treat the patient, not the scan." He needs the actual films for surgery day, he says, not a CD. > Could you just summarize the abstract for me? It's long and very detailed, it reviewed quite a few studies. It's an extremely inaccurate too, to summarize. Susan > x-no-archive: yes > [quoted text clipped - 22 lines] > > Susan If I remember correctly the report basically said that the CT scan had about 40% rate of false positives and a 40 percent rate of false negatives. In other words if your CT scan is negative and you still have the gluey goo, it does not mean that you don't have sinusitis, just means that the goo is not dense enough at that moment to show up dramatically. There is definitely information there for the skilled practioner, but it more often than not a medical Roche than anything else and is a procedure that contributes $1500.00 to the partnership that owns the CT, which is often the ENTs. On Jun 25, 12:56 pm, indian_m...@tx.rr.com wrote: > > Is this from the radiologist's report? > [quoted text clipped - 24 lines] > > Michelle There is something I don’t follow in this thread. I don’t understand why the ENT suggested sinus surgery as a treatment for sinus inflammation absent of an infection. I thought sinus surgery was usually to either clear out infections or address anatomical problems. What does sinus surgery on inflamed sinuses absent of infection accomplish? Thanks, Mason > On Jun 25, 12:56 pm, indian_m...@tx.rr.com wrote: > [quoted text clipped - 37 lines] > > Mason It is usually a biofilm infection and scraping a good portion of it off can often lessen the burden of infection and thus the symptoms for a couple of years until it grows back. Unfortunately medicine is a very young science. Look up biofilm sinusitis in pubmed.gov. Cultures for bacteria have up to a 60% false negative rate, partly because most of the bacteria are what is called fastidious and won't grow in a mono-culture, partly because the biofilm forms of pathogens may not grow out vigerously in the culture mediums used, and partly because when known pathogens do show up in cultures they may not grow out or be present in numbers that meet the minimum number to be reportable. The biggest elephant in the room is that most bacteria live in multispecie colonies called biofilms, patches like lichens where the bacteria gained a foothold after respiratory viruses kill or parallelize the goblet cells and cillia that normally defend the epithelium from colonization. So if the sinuses are chronicly inflamed the docs don't know exactly what they are up against, but they know that if they scrape it out, things sometimes get better. Surgery often follows the path that the person gets worse for three months after surgery then gets better for about 6 month, there is a golden year when everything is wonderful, and then things get back to pretty much where they started at the end of the 3rd year. |
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