I lost my sense of smell after a dental extraction. Will it come back?

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I lost my sense of smell after a dental extraction. Will it come back?

Question:       
I had an upper left molar tooth extracted last month. The extraction was painful, for more than 20 min. the dentist pushed my head, pulled and twisted the molar. I had a sinus perforation which laer was confirmed through a dental x-ray (not panoramic or whole head). I was visibly swollen, after the lidocaine wore off, I had a debilitating head ache (only left side) for many days and on two consecutive mornings after the extraction, a very watery yellowish liquid suddenly ran through my left nostril, when I bent my head forward. On the second occasion, I collected it on a paper and it formed a pinkish center with a yellow ring around it. The handkerchief did not stiffen, and I have a serious suspicion the leak might have been a sudden CSF leak (CSF rhinorrhea) due to the blunt trauma on my head. I suspect my cribiform plate was broken as I had a very sharp pain in the whole bony area around my nose and left eye for many days. I also lost my sense of smell in my left nostril after the sinus perforation and tooth extraction. My sense of smell was perfect before, if not even too much sharp. Nowhere I could find corroboration on the fact that anosmia can be caused by sinus perforation – something which my dentist claims is normal. On the contrary, I found many scientific reviews which state that anosmia can be due to damage of the olfactory nerve and after a CSF leak through the eustachian tube, caused by fracture of the cribiform plate or petrous bone (if the fistula is in the middle ear). I also had  very strong headache on the left temporal bone, just above the ear…
Please can someone tell me whether my anosmia is going to be permanent (one month already) and whether I might have had the CSF leak due to the blunt trauma of the tooth extraction and sinus perforation? The liquid did not resemble any mucus, it was watery and sudden gush. I am still waiting for the day where a surgery will be done to close the sinus communication via cutting and stitching on my gums (it will be after 3 weeks).
Is anosmia typical for sinus perforation? I have a burning sensation in the base of my left nostril and a feeling of excessive dryness. For a week or so I started having a mucous liquid running down to my throat, I am sure that this is from the sinus, however, and not a CSF leak which may have resorted on its own after several days.

Thank you very much for reading this,
I appreciate a lot your time and energy to help!

Kind Regards,

Answer:

First of all, thank you for your question.  This obviously has been a difficult time for you.  I will try to answer your question(s) as best as possible, without having examined you.

It is not rare for someone to develop a sinus infection after an upper molar infection or extraction.   The roots of the upper molars are very close to and sometimes in the maxillary sinus.  The bacteria that  we have in our mouth can then spread into the sinus easily causing infection.  The bacteria of the oral cavity, in particular,  tend to be worse than those we have living normally in our nose and sinuses, and can cause quite significant infections.

It seems likely, that you had a sinus infection from your dental problem.   This needs to be treated aggressively, with antibiotics based on a culture of your sinus discharge-  and sometimes by drainage-  surgically or with a balloon sinuplasty (balloon dilating of the normal opening of the sinus – done in the office.

You can certainly have a temporary- or even permanent loss of the sense of smell (anosmia) from infection.  One needn’t postulate a break in the roof of the sinus (cribiform plate)-  Although your description of the mucous drainage is consistent with a leak of brain fluid (CSF)- the best way to diagnose this would be to collect the fluid and to have it tested –  (Beta Transferin is used as a marker)-   Even less likely would be a leak of fracture of the petrous apex (inner ear)-  as this usually will cause a hearing loss from fluid collecting in the middle ear- and will not often cause drainage through the nose.

Certainly, I would suggest ct scanning of the sinuses to make sure you do not have a persistent infection- and to look at the area where one could find a tear causing a leak of brain fluid into the nose.  I am not sure how a dental extraction could cause a fracture of the roof of the sinuses, however.

Lastly, one needs to find out the cause of your loss of smell to give you the best idea of how to treat this and whether the smell will return.

If there is a persistent infection of the sinuses, it certainly can cause  loss of smell and your sense of smell will usually (not always) return once the infection has resolved.

If you have a leak of brain fluid,  (CSF Rhinorrhea)- that needs to be treated-

Traumatic anosmia-  loss of smell from head trauma- has a less favorable  outlook than other causes.

In any case- you should really be seen and evaluated by an Ear Nose and Throat doctor-  or sinus specialist (rhinologist) who deals with smell and taste problems to see what you should do next.

I hope this clears things up.

Robert Pincus MD

Associate Professor Otolaryngology NY Medical College

Co-Director  NY Sinus Center

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Will balloon sinuplasty help my runny nose and deviated septum?

Question:    

I was diagnosed with a chronic runny nose due to having a small nasal opening for drainage and a deviated septum. Am I a candidate for Balloon Sinuplasty?

Answer:   

Thanks for your question.

Balloon sinuplasty is a wonderful new technique for opening the sinuses.  Sinuses are small air filled pockets around the nose that drain into the nose.  If blocked, we can get recurrent infections of the sinuses.  Balloon sinuplasty is a non-surgical technique in which we find the opening of the sinus, thread a small catheter into the opening, and then briefly inflate the balloon- widening the drainage site.  We then remove the balloon.  The results have been excellent with this procedure.  There is no down time and sinuplasty  is done in the office with just a local anesthetic.

You can read more about this on our web site- below

http://www.nysinuscenter.com/2011/01/balloon-sinuplasty/#more-535

Unfortunately, to date, we have not been using balloons to straighten a twisted (or deviated) septum.  The septum is the center wall of the nose, and while it is never straight, a significant bending or twisting can block up the nasal passages or even make one more susceptible to sinus infections.

If the sinuses are sinuses are blocked, then sinuplasty may have a role in your care.

If you’re in the NY area, we’d be happy to evaluate you for balloon sinuplasty, here at the NY Sinus Center.

I hope this clears things up.

Robert Pincus MD

Co-Director NY Sinus Center

212-889-8575

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.

Can you send any encouraging word?

Question:

On 10/1, my 41 yo daughter had surgery for removal of a moderate-sized nasal polyp and sinus surgery. For months prior to the procedure, she received antibiotic & steroid therapy in an attempt to help with chronically infected & painful frontal sinuses & a blocked passage.

Unfortunately, on the second post-op day, she developed excruciating headache and eye pain on the side of surgery (R). It became so severe that she was told to see the surgeon yesterday, 10/5, when she reported stabbing pain along the right cheek, into her eye & head.  The surgeon suctioned her of quite a bit of debris, started her on saline rinses and told her to take two Vicodin q 6 h, and one Aleve  at the midway point of the Vicodin doses. Additionally, she is on 30 mg of Prednisone daily x5 days, to decrease tomorrow to 20 mg daily x 5d, then 10 mg daily x5d, then discontinue.

My apprehension about her pain has grown tremendously since googling sinus post-procedural pain & the rare risk of eye or brain issue following this procedure.  My daughter had an MRI in addition to the normal  CT scan prior to procedure since the surgeon felt he needed to more definitively tell whether or not the lesion in her nose was a polyp vs encephalocele, due to its position. Following surgery, he did state that it definitely was not an encephalocele. Although it is the weekend, my daughter was told to call (the surgeon) if any vision problems at all occurred, which thankfully has not happened.

I would so appreciate any information or tips you may give.  I assume it is too early to think about having my daughter see an ENT or other specialist (?) at the Univ. of Miami at Jackson Memorial, a 1-2 hr trip from home.  I am not sure how soon she could be seen either, but am afraid of “waiting this out” to see if her vision becomes affected????  Any help would be MOST appreciated.

Can you send any encouraging word?

Answer:

Thanks for your note.

I wish I could answer completely without knowing your daughter and her surgery more personally.  However, as you know, complications with the eye and even intra-cranial (brain) complications are possible, but quite rare with nasal and sinus surgery.  As a surgeon, I would be quite concerned should my patient have significant pain after surgery (it is rare as well).  However, it sounds like the surgeon checked to see that there was no complication at the visit.  Should there have been a complication with the eye, one would be most concerned about visual loss, double vision, getting black and blue around the eye or loss of vision.  It sounds like she has not had any of those issues.  Intracranial complications (brain fluid leaks, etc) rarely cause such pain either.  One would most likely see a clear fluid discharge-  Headache would be possible if there were meningitis- but one would expect other findings as well, such as a stiff neck.

It sounds like she is in good hands (appropriate to have checked to see with MRI as well as CT that this was not an encephalocele) and I would follow up as your daughter’s surgeon suggests.
Should she have questions or concerns, of course we’d be happy to see her up here at the NY Sinus Center.  One wonderful sinus specialist closer to you is Donald Lanza- in Tampa.  But by your description alone, I do not see anything that makes me feel your daughter’s care has been anything but good or that she needs other urgent intervention.

I hope this helps clear things up.

Robert Pincus MD
NY Sinus Center

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 have persistent headaches and dizziness. Will I have to suffer with this the rest of my life?

Question:

I have had numerous sinus surgeries – I have even had the sinus cavity in my forehead removed and filled in with artificial bone material. I have have been cut so many times in my eye brow area. I continue to have severe headaches everyday. I have been told that my headaches come from the damage to the nerve endings in my head due to so many sinus surgeries. About 4 years ago I developed Vestibular Neuritis – my right ear now controls the balance for my body – but this has made my headaches worse and if I get very tired or stressed the balance issue becomes worse. My life has totally been affected by all of this – I go to work and back home – I cannot stand to be in a crowd or hear loud noise – I have been to several ENT and ear specialists and even the head of the ENT at Southwestern Medical in Dallas and they all say the same thing – I will have to suffer with this the rest of my life.

Answer:

Thank you for your question. You really have at least two problems that affect each other. While both are troublesome and difficult, neither is impossible to manage.

Headaches can often be from sinus problems- but other issues can cause headaches as well. However, about 10% of people who have had bone flaps for their frontal sinuses wind up having persistent nerve pain in the area. With today’s minimally invasive procedures- such as image guided endoscopic surgery and balloon sinuplasty- that procedure is rarely done, except for a persistent bone infection (0steomyelitis) of the skull. If the infection has resolved, the pain may be treated with medications for nerve pain and sometimes with an anesthetic injection and steroids into the area of the nerve.  Sometimes the root of the nerve causing the pain can be cut- though this may require a procedure from neuro (brain) surgeon.

One can have damage to the balance nerve from many sources- the most common cause, we believe, is may be from a viral infection that damages the nerve. Sometimes, the damage is permanent- however, in general, the brain and the inner ear learn to readjust. I am not sure how long this has been a problem, but if persisting, we recommend balance (vestibular) therapy, which helps in most people. Frequently, when ill or under other stress, this learned readjustment can stop working well. That would cause the symptoms to temporarily, to recur.

It is imperative, of course, that other causes of imbalance have been checked for, and ruled out.

I hope this helps clear things up a bit.

Robert Pincus MD

Co-director NY Sinus Center.

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