sinus headache | The New York Otolaryngology Group

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Salty Post Nasal Drip with Headaches After Surgery

Question
For nearly 3 years I have been getting salty post nasal drip with headaches. I had a CT scan of my sinuses which showed only mild to moderate mucosal thickening. I had FESS bilateral unicectomies, middle meatal anthrostomies and anterior ethmoidectomies.

I wish I never had the surgery done, the salty drainage is so bad, I’m constantly coughing in tissues and have a constant high-pitched ringing in my ears. I have really bad anxiety and depression since the operation. I feel so ill everyday. I’m 22 year old female and it’s ruining my life.

I think I might have a csf leak. Had beta 2 transferrin test, which came back negative. I coughed the fluid from the back, I dont get any out the front of my nose. My recent CT scan doesn’t show any evidence of a leak. Been tested for allergies and am not allergic to anything.

What can I do? Thank you.

Answer
CSF Leak HeadacheThanks for your note.
It is really hard to let you know without a complete examination, and it sounds like you have been cared for appropriately without the results one would really hope for or expect.
I definitely would suggest further evaluation for csf leak or increased intracranial pressure.
Any medications you are taking need to be looked at. At the NY Sinus Center, we would also look whether there is Gastro esophageal reflux as high as your sinuses causing these symptoms, usually by Restek pH monitoring in the nasal cavities.
Unfortunately, very often sinus problems are complex, rather than straightforward, and treatment really requires understanding the cause of one’s problems.
Robert Pincus MD
Co-director NY Sinus Center
Let’s clear things up
If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

Developed Sinusitis After Lafort Procedure

Question

I had a Lefort 3 procedure for TMJ and a maligned jaw in October 2014.

Almost immediately after surgery, I felt a tract from my nose running into my cheek, and my cheek on that side was definitely more swollen.

Lefort Procedure ComplicationsThen I developed sinusitis and have been on numerous courses of antibiotics since then with little or no relief. I have seen 2 ENT surgeons. I had two endoscopy sinus biopsies and both were negative.

I now have pressure and pain on my nasal bridge. I still just don’t feel well and have sinus headaches.

Can you suggest anything and possibly consider a 2nd opinion? I have had edodontist care to check my root canals and they are fine.

My 2 CT scans were apparently negative. Please help!

 Answer

I would suggest another ENT and possibly OMFS consultation/opinion. If you are in the New York area I suggest seeing Dr. Robert Pincus or myself at our practice. If you are not in the New York area we might be able to suggest an expert closer to you.

Hope this clears things up!

Scott Gold, MD

 

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

Peppermint tea causes me to have a sinus headache after sinus surgery

Question:

I had several procedures done with sinus surgery (turbinoplasty, FESS) 4 weeks ago. I followed dr’s instructions as far as diet, and activity during the recovery period. It all went very well, minimal pain, until this week when I started drinking peppermint tea daily. I didn’t make any connection between the two, but my sinuses start hurting right after the tea. As a matter of fact, one day I had two cups of the tea and the pain was really bad. Is there a connection between peppermint and sinus surgery (or any sinus condition)? I thought peppermint was good to treat sinus problems. Thank you.

Answer:

Thanks for your question.

This really is rather interesting.   We  have found and reported in the medical literature  that acid reflux (either known or “silent”) is a frequent cause of chronic sinusitis.  In our study, eight of eleven patients with sinusitis who failed regular medical care, had significant reflux of stomach acid as high as the sinuses.   Patients were studied over a 24 hour period with pH (acid monitors) in the back of the nose.  In these patients, reflux was the likely cause of their recurrent infections.  Most had no or few other symptoms of reflux and  found that their sinus problems improved or resolved when their reflux was treated (diet -with or without medications).  Surgery can often be avoided with such treatment.

One of the more common agents worsening reflux is peppermint.  Please see the page below for some more information

http://www.nysinuscenter.com/treatment/

While there may be some other, unexplained etiology, acid reflux is by far the most likely cause of these symptoms- and may have been part of the cause of your sinus problems that necessitated surgery.

I would ask your surgeon to evaluate whether you do in fact have reflux which may be worsening your symptoms.  If so, treatment will likely lead to a  better long-term outcome from your surgery.

Clinical evaluation may be enough, but at times we  do 24 hour pH testing in the nasopharynx.  This accurately measures whether acid is in fact coming up to your sinuses, when it happens and what exacerbates the problem.

We would be happy to evaluate you here at the sinus center if you are in the NY area.

I hope this clears things up.

Robert Pincus MD

Co-Director NY Sinus Center

Associate Professor Otolaryngology

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

I have severe sinus headaches and my doctor is considering balloon sinuplasty

Question:

I have been dealing with terrible headaches for along time. I went to the emergency room roughly 9 months ago with an excruciating headache.  They did a CT Scan and found that I had chronic sinusitis and a small retention cyst in my right maxillary.  I followed up with an ENT who is trying to treat it with nasal sprays.  Months later I felt some numbness above my left eye and had another CT scan which still proved chronic sinusitis but nothing wrong with the brain.  It is now August and my symptoms: daily headaches, pain between eyes and top of the head and temples, still are present. It is truthfully affecting my life and I can’t stand the pain.  My ENT mentioned a balloon sinuplasty but is now telling me it would have to be proven for me to have the procedure. Please help because this pain is awful.

Answer:

Thank you for your question.

Headaches are always a difficult problem.  While sinusitis may be the cause of headaches, there are many other types of headaches that can be excruciating and difficult to manage as well.  It would be important to see what your sinus CT shows.  Should there be significant or persistent inflammation in your frontal sinuses (the sinuses in the forehead), then balloon sinuplasties may be helpful for you.  In balloon sinuplasty,  the doctor places a thin wire into the opening of the sinus- then inflates a balloon for about 10 seconds.  This results in a wider drainage site for the sinuses- and should alleviate frontal sinus infection.   It is done in the office, with local anesthetic- and there is virtually no down time.  We do this frequently here at the NY Sinus Center and you can read more about it on our site,  nysinuscenter.com-

However, as you can well imagine- this will not likely help you if your headaches are from migraines, muscle tension, cluster headaches- or other causes.

Sinus headaches will often respond temporarily to a course of antibiotics and nasal or oral steroids.  Migraines may present with visual changes (aura) or respond temporarily to a medication such as sumatryptan taken at the onset of the headache.

We’d be happy to see you here at the NY Sinus Center and help clear things up.

Robert Pincus MD

Co-Director NY Sinus Center

Associate Professor Otolaryngology

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

I can’t breathe from my nose after jaw surgery

Question:

Hello,

I had upper and lower orthognathic surgery two years ago which involved cutting into my sinus area. My surgeon found polyps and removed them. Ever since my surgery my sinuses (near the bridge of my nose) have been congested. I can’t breathe out of my nose very well and my left ear feels blocked and pops often. This sinus pressure leads to headaches about 5 times a week.
I have been prescribed various antibiotics, nasal sprays, and sinus irrigation – nothing seems to help. I have had a CT scan and an MRI and nothing seems to look abnormal to my surgeon and two ENT doctors that I went to see. My surgeon said all he saw was that my ethmoidal sinuses seemed like debris from the surgery had settled in them, but the ENT said he didn’t agree.

Wondering if you have an opinion on what could be wrong. I’ve become desperate!

Thank you so much!

Answer:

I wish I could easily answer your question. There are many different possible causes for your current symptoms. As you know, upper orthognathic surgery may cut through the maxillary (cheek) sinuses or even through the ethmoid sinuses (near the eyes- Leforte III type osteotomies).  Orthognathic surgery is done on the bones of the upper and lower jaws, usually by an oral surgeon, to better align the bite and/or to improve ones facial appearance where the lower and upper jaws are too small or too big.  While not usual, sinus problems can ensue from this with the best of surgeons. I would think, however, that such obstruction or drainage issues should be found on your sinus films.

One thing that may be more easily overlooked is the development of a nasal valve stenosis or narrowing- The nasal valve is just above the nostrils, where your nose opens and can lose support from surgery or other cause.
This can be diagnosed by pulling out on your cheek, just where it joins the nose inferiorly- and seeing whether that improves your symptoms. The subtle anatomy there can be changed from  surgery or other causes and give you nasal obstruction- and be overlooked.  Breathe-rite strips may temporarily improve one’s symptoms in this case.

Of course, there are other possibilities that may be unrelated to the surgery- including recurrence of polyps or new sinus problems –

We would be happy to see you here in the sinus center. If you can come in, please bring your most recent sinus CT scans, and earlier ones as well if available.

 Robert Pincus MD
Co-Director NY Sinus Center
212-889-8575
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