What Does The CT Scan Report Indicate?

Posted on Tue, 21 Apr 2015

Question: Hello DR,

My CT scan is currently demonstrating, "New from 8/7/14 is partial Opacification of the nasal cavity and Maxillary sinus mucosal thickening. **The Ostiomeatal units are also opacified bilaterally".

Quick hx: I am a 57 yo female and have been suffering with periodic, (frequent) loss of my voice X 14 months. For many months, I was coughing up mucus with runny nose. In 8/14 initial CT scan did not show these opacities. The UCLA ENT stated that although I didn't fir, "the usual physical profile", (I am slim and generally walk 3 miles at least 3 X's / week), that I have GERD, which would account for the frequent loss of voice. Despite having no other sx of GERD, I have been taking generic Prilosec BID for 6 months with no change in vocal impact.

Most recently, (past 4-5 months), rather than a productive cough, etc...I am overly dry, sinuses completely blocked, still with loss of voice. I can no longer exercise, 2/2 flu like sxs s/p exertion, (immune symptoms?).

My current UCLA Allergist appears a bit perplexed by the current CT impression, (the language re: the ostiomeatal units being opacified). She is endorsing a course of Prednisone X 5 days with 6 weeks of Augmentin.

I am exhausted from the sxs and am concerned re: GI effects of the Augmentin without a more informed opinion. Could this perhaps be a mucocele??

Thanks for a considered opinion!
XXXXXXX Land, LCSW @ UCLA

Answered by Dr. Sumit Bhatti (4 hours later)

Brief Answer:
Upload CT images.

Detailed Answer:
Hi,

Thank you for your query.

1. If you upload the Sinus CT images, I will be able to give you an accurate assessment. A mucocele will not be missed on the images. Images or a video of a video-laryngoscopy or ideally a Stroboscopy will add immense value.

2. It is not unusual to have different findings in the Sinus CT scans taken at different times during an active disease process. Sometimes the scan findings in the same patient vary within a few days.

3. It seems from your history that a Post Nasal Drip (PND, secondary to chronic sinusitis) is more likely to be a cause for the cough and voice change than the GERD.

4. The first line of treatment is medication. I would add an anti-allergic, mucolytic (such as bromhexine / ambroxol), OTC nasal decongestant (such as 0.1% xylometazoline, short term) and steam inhalation. For the GERD or LPR (Laryngo-Pharyngeal Reflux which is GERD without other s/s), I would confirm with the laryngeal images and give a trial of another PPI (Proton Pump Inhibitor/ Prilosec) such as rabeprazole and a gut motility enhancer such as levosulpiride. A PND and GERD do worsen each other in a vicious cycle.

5. The most common side effects of Augmentin will be loose motions and skin rashes. It is surprising that you were given multiple courses of Tetracycline as a child.

6. If the medication does not give an improvement, Balloon Sinuplasty will be a good option in your case.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.

Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar