Question: I had punctured sinus during left molar extraction. The socket was not closed properly and needed repair work 4 days later to close socket. I have had bouts of nasal congestion, burning sensation in nasal cavity, light headedness. Tilting my head back seems to help sometimes. I am not sure my sinus healed properly. Have had pulling sensation in left nostril. Noises in left ear have been diagnosed as eustachian tube dysfunction. First problem with ear was suctioning sound when I yawned (socket had sealed). Then clicks when congested. Now clicks randomly. Can an MRI show if my punctured sinus has healed properly or is a CT scan required?
Answer: First of all, thank you for your question. The roots of several teeth- especially our molars, can be quite close or actually within the maxillary (cheek) sinus. Infections in the tooth roots or dental extractions can spread infection into the sinus- and are typically difficult to treat as the oral bacteria are often quite virulent.
Treating odontogenic (dental caused) sinus infections involves appropriate antibiotics- usually best based on an actual culture- and treating the dental problem.
Today, we will often use balloon sinuplasty- opening up the sinus with a balloon in the office- to drain the sinuses if needed.
The best way to see if a sinus infection has resolved is with CT scanning. Low dose scans can be done, and while the radiation is less than with typical scans, there still is some radiation. MRI’s use electromagnetic waves rather than radiation, but do not show bone- and tend to over read sinus problems. They are much less useful, but a normal sinus MRI would probably be enough to avoid using CT scanning.
I hope this clears things up.
Robert Pincus MD, FACS
Co-director NY Sinus Center