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What Does This CT Scan Regarding Chronic Left Post-nasal Thick Drainage Indicate?
Question: I have chronic left post-nasal thick drainage. I have chronic difficulty breathing through my left nose. I have perennial allergies and have successfully been on maintenance therapy X3 years. I have had three CT's (2007, 2010, 2014) related to my sinus problems. I occasionally blow out through my nose what looks like early tonsillolith material (white, clay-like, fetid). I do not have tonsillar crypts or other tonsil problems. I feel that I have chronic infection in posterior ethmoid/sphenoid that has never resolved. Am I a surgical case? What is your first impression with my CT results?
Brief Answer:
As below:
Detailed Answer:
Hi,
Thank you for your query.
1. These are the CT findings based on the limited images attached:
a. DNS (Deviated Nasal Septum) to the left
b. Bony Septal Spur on the left
c. Paradoxical Middle Turbinate on the right
d. inferior turbinate hypertrophy on the left
e. Hyper-aerated Maxillary Sinuses, clear with dental roots closely related to the floor of the Maxillary Sinuses.
f. Minimal mucosal thickening in the left Ethmoid Sinuses
g. The Sphenoid Sinus:
2007: Minimal mucosal thickening / retention cyst in the Left Sphenoid Sinus.
2010: Definite reduction of the mucosal thickening.
2014: Further resolution. Air bubbles in the above area, more likely to be secretions, may be fungal.
2. You are definitely not a candidate for FESS (Functional Endoscopic Sinus Surgery).
3. Request a trial with an anti-histamine, an anti-leukotriene, a mucolytic, a steroid nasal spray and regular steam inhalation for at least two weeks.
4. If medical treatment fails, a Limited Septoplasty with spur removal may help reduce your PND (Post Nasal Drip). This may be combined with Balloon Sinuplasty of the left Sphenoid Sinus with culture sample(bacterial, fungal) / careful biopsy of the posterior area.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
As below:
Detailed Answer:
Hi,
Thank you for your query.
1. These are the CT findings based on the limited images attached:
a. DNS (Deviated Nasal Septum) to the left
b. Bony Septal Spur on the left
c. Paradoxical Middle Turbinate on the right
d. inferior turbinate hypertrophy on the left
e. Hyper-aerated Maxillary Sinuses, clear with dental roots closely related to the floor of the Maxillary Sinuses.
f. Minimal mucosal thickening in the left Ethmoid Sinuses
g. The Sphenoid Sinus:
2007: Minimal mucosal thickening / retention cyst in the Left Sphenoid Sinus.
2010: Definite reduction of the mucosal thickening.
2014: Further resolution. Air bubbles in the above area, more likely to be secretions, may be fungal.
2. You are definitely not a candidate for FESS (Functional Endoscopic Sinus Surgery).
3. Request a trial with an anti-histamine, an anti-leukotriene, a mucolytic, a steroid nasal spray and regular steam inhalation for at least two weeks.
4. If medical treatment fails, a Limited Septoplasty with spur removal may help reduce your PND (Post Nasal Drip). This may be combined with Balloon Sinuplasty of the left Sphenoid Sinus with culture sample(bacterial, fungal) / careful biopsy of the posterior area.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. Bhatti,
Thank you for your very detailed analysis. I agree 100% with your findings. You mentioned me having a limited septoplasty. What do you mean by "limited" v. a more extensive septoplasty?
Thanks!!
Thank you for your very detailed analysis. I agree 100% with your findings. You mentioned me having a limited septoplasty. What do you mean by "limited" v. a more extensive septoplasty?
Thanks!!
Brief Answer:
Answers below:
Detailed Answer:
Hi,
Thank you for writing back.
1. Limited as in an endoscopic septoplasty or a very conservative septoplasty with removal of the bony spur and very little of the cartilage.
2. I would prefer a combined technique. Traditional septoplasty with the help of a nasal endoscope.
3. Extensive septoplasty would be like an SMR (Sub-Mucous Resection of the Septum) and even extracorporeal septoplasty.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
Answers below:
Detailed Answer:
Hi,
Thank you for writing back.
1. Limited as in an endoscopic septoplasty or a very conservative septoplasty with removal of the bony spur and very little of the cartilage.
2. I would prefer a combined technique. Traditional septoplasty with the help of a nasal endoscope.
3. Extensive septoplasty would be like an SMR (Sub-Mucous Resection of the Septum) and even extracorporeal septoplasty.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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