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.

Sinus Drip and Dry Mouth

Question:
I have a leaking in my sinuses which leaks down the back of my throat. My saliva is very thick, which leaves my mouth dry all day everyday. I drink a sufficient amount of water daily to combat this, however its been to no avail.
My breath stinks all day. Constant brushing does nothing to help.
Please Advise.
Thank You.
Answer:
I would advise a consultation with an ENT specialist. You could have a sinus infection and or silent acid reflux.
Hope this clears things up.
Scott D. 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.

I have lost my sense of smell and my doctor says it cannot be treated

Question: 

I have a question for Dr. Robert Pincus. I was prescribed oral steroids (methylprednisolone 4mg) due to loss of smell. I took the 7 day regime of oral steroids. About 10 days after completing this treatment I again lost my sense of smell. My doctor said this could not be treated. I am seeking a second opinion from you. Thank you for any information you can provide.

Answer:

Thank you for your question.  It is not hopeless when you have lost your sense of smell.  There are two main reasons that we lose the sense of smell.  The first and most common is that there is congestion in the nose at the area of the cribriform plate (the top of the nasal cavity) where the smell fibers are located.  This happens when we have a cold or often from a sinus infection or nasal polyps.   Obviously, these are not only treatable, but will almost always get better.

Damage to the smell fibers themselves, either after a viral infection, trauma, breathing in certain toxins, or other causes are more difficult to treat.

At the NY Sinus Center we believe it is important to find out what has caused your loss of smell and aim our treatments at the particular cause of your problem.

The fact that your smell improved temporarily with oral steroids is an EXCELLENT sign that your sense of smell is both treatable and more likely to be regained.  We would be happy to try to help.

I hope this helps clear things up.

Robert Pincus MD

Co-Director NY Sinus Center

NY Otolaryngology Group   ” Care beyond excellence”

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 had punctured sinus from left molar extraction. Can an MRI show if my sinus has healed properly?

Question:  

Had punctured sinus (during left molar extraction).  Socket was not closed properly.  Had to have repair work done 4 days later to close socket.
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.  Popping sound when I burp sometimes and the most recent is pressure in ear as if underground on train.

Can an MRI show if my sinus has healed properly?  Any image that is not radioactive?

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

 

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 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

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.

Question: Can sinus problems make you cough? My husband is being coughing for many many years and he has so many test done and doctors can’t find anything wrong but the cough won’t stop.

Question:     

Can sinus problem make you cough?  My husband is being coughing for many many years and he has so many test done and doctors can’t find anything wrong but the cough won’t stop.  Desperately need help and don’t know where else to go.  Please help.

Answer:

Thank you for your question.   As I am sure you know, a persistent cough can be a vexing and debilitating problem.  It is something we see quite a bit of here at the NY Sinus Center.   Obviously, one of the first things to do is to make sure that the problem is not coming from the lungs- such as from pneumonia or bronchitis.  I would expect that this has been done.

We at the Sinus Center see cough from several different causes.

1.  Sinusitis- an infection of the sinuses can cause a persistent cough when inflamed mucous or pus drips down from the sinuses into the throat.  It should certainly be evaluated by an ENT exam, nasal endoscopy and sometimes by a sinus scan (CT).

2. We frequently see a persistent, dry cough, from acid reflux.  Acid can come as high as the throat, hit the vocal cords and cause an irritation that makes you cough.  At the Sinus Center, we often test for this kind of reflux by our exam, but also by a 24 hour evaluation of acid exposure (pH testing).

3.  One can also have a persistent cough from an irritated nerve that goes to the voice box (neurogenic cough)

4.  Finally, there are even more unusual causes such as a persistent Pertusis (whooping cough) infection that we are now seeing more commonly in adults, previously vaccinated.

All of these causes are quite treatable- but the treatment recommended is different for each and one must make the correct diagnosis for therapy to be effective.

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

Robert Pincus MD, FACS

Co-Director 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 lost the sense of smell (anosmia)

Question:   
Dear Doctors,

I have been suffering from anosmia since approximately July 2012.
I had no illness around that time (have not had a flu since 2002), and had no injury of any kind. I do have strong hayfever allergies but those have been present all my life.I have had an MRI done  and no one has ever identified anything wrong with it, nor has looking up my nose with an endoscope revealed anything.

The reason for my email is this: All the doctors I have seen so far, once they are up to speed on the above information, have given up surprisingly quickly on the idea of trying anything.

Answer:

The loss of the sense of smell can be quite debilitating.  The sense of smell is important for our day to day safety (to determine if food has gone bad, if there is a gas leak), for our enjoyment of life in general, and can be a precursor or indicator of other neurologic problems.

Evaluation includes a thorough history, quantification by smell testing,  ear nose and throat evaluation and nasal endoscopy, and imaging studies such as an MRI.

Many times, but not always, the loss of smell can be reversed or improved.  Obstructing polyps can be shrunken or removed, inflammation- such as after a viral infection may be treated with steroids, orally or in the nose. Infection can be treated with appropriate antibiotics, if needed.

More recently, several studies have shown that in those people whose loss of smell persists, other newer therapies may be helpful.

Theophylline has been used orally- and often can be of help.

Smell therapy- also has been shown to be a benefit in many people as well.

Unfortunately, oral theophylline has many side effects-   We have been using a topical nasal spray with theophylline for such patients-  The study results have been promising.

We’d be happy to see you at the NY Sinus Center to review your previous studies and treatments to see if we could suggest other therapies- such as intranasal theophylline or smell therapy- and to make sure that no other treatable cause has been missed.

Robert Pincus MD  Associate Professor Otolaryngology

Co-Director 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.

Is bloody mucus a sign of a sinus infection?

Question:  I have this head cold and blow my nose there is blood in the mucus which I think is a sinus infection.

Answer:

Bloody mucus is a sign of irritation in the nose.  This can come from trauma, dryness (quite common in cold weather with the heat on), chemical inflammation,  infection- viral or bacterial, and least likely from a tumor or other growth.  While it is quite common with a sinus infection, there are other causes and if you have this persisting, it should be evaluated by an Ear, Nose and Throat Doctor or Sinus Specialist, using a lighted telescope in the nose to evaluate.

I hope this clears things up.

Robert Pincus MD

Co-Director 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.

What could be the cause/reason for on/off nose bleeds from 1 nostril frequently?

Question:  What could be the cause/reason for on/off nose bleeds from 1 nostril frequently?

Answer:

First of all, thank you for your question.  Recurrent nose bleeds (epistaxis in medical terms) is quite a common problem.  We see this most often during the winter when the heat is on.   If we heat room air from 30 to 65 degrees, the humidity drops down to levels one sees in the desert.  The mucous membrane lining of the nose then can dry out and crack, causing a nose bleed.   It there is a prominent blood vessel on one side- or if the septum- (center wall of the nose)  is deviated (twisted)- then there can be a prominent point on the wall that the air hits and dries out faster-   Both of these will cause nose bleeds to be more common on one side.

If you are taking aspirin (even baby aspirin) or a blood thinner- then the bleeding can often become more problematic- as these medictions delay the forming of a clot- or scab-

When the lining of the nose is more swollen (from a cold, allergies or a sinus infection- among other causes)- then there is a greater blood flow to the nasal lining and that also makes people more susceptible to nose bleeds.

Lastly, and thankfully least commonly, there can be a growth- benign or malignant tumor- in the nose that causes bleeding.

Try to keep the nasal passages moist in the winter-  use topical saline sprays, ointments to the tip of the nose, humidifier if you can keep clean,-

If you have a nose bleed-  put some cotton in the nose- with afrin(oxymetazoline 0.05%) if you have- and find a clock.   Then pinch the bottom of your nose for 5 minutes (about the time it takes to form a clot in most people)- but longer if you are taking a blood thinner.

If the bleeding persists, you need to seek medical care-   And if you continue to have bleeding from one side of the nose, even if it stops- it is important to have your nasal cavities evaluated to make sure there is no worrisome cause, and to see if there is a blood vessel that needs to be cauterized.

I hope this clears things up.

Robert Pincus MD

Co-Director 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 atrophic rhinitis. I felt great after one month of Levaquin, then it came back.

Question:

Thank you very much for allowing us to ask questions.
I have atrophic rhinitis. Can this be caused by allergies?  I have many airborne allergies. Also how would you culture the bacteria? Mucous ?  Or swab(this does not seem to work) ? I took one month of levequin and for that month and the month after I felt great.  Then it came back .  Is there a better protocol?  I saw medical articles that said  3 months of cipro,  or rifampin or streptomycin injections where curative.
Any guidance would be truly appreciated.

Answer:

Thanks for your question.  Atrophic rhinitis implies that the tissues of the nasal and sinus cavities are damaged and have lost much of their ability to function well.  The job of the nose and sinuses is to humidify and warm air (to 98.6 degrees and 100% humidity) by the time the air gets to the back of the nose.  The mucous is both a lubricant and catches particles (viruses, bacteria, dust, etc) and brings them down the back of the nose to the throat where they are swallowed and destroyed by stomach acid.

Atrophic rhinitis is usually NOT caused by allergies- but more commonly by damage to the tissues- either from removing too much during a surgical procedure- or from scarring from infection, caustic nasal medication (cocaine, afrin abuse) or sometimes an unknown cause.

Allergic rhinitis is called Atopic rhinitis- so you just want to be sure of the correct terminology.

Atrophic rhinitis can be  best treated often with topical medications in the nose-  ointments such as Bactroban placed on a finger tip just on the inside of the nose-  and with nasal rinses (SaltAire, NeilMed)- at times with medications such as antibiotics and steroids in the rinse.  Alternatively, the use of sinus nebulizers (deliver fine mists) with hypertonic (extra salty) salt water with or without the same medications can be helpful.

Sinus cultures need to be taken of the mucous directly where it comes out of the sinuses to be accurate.  This needs to be done with a telescope in the nose  (a blind nasal swab is not helpful) and I would expect this to be done by any sinus specialist.  While we know the most common organisms causing sinus infections statistically, each individual may have an unusual organism and it is always best to treat with the most appropriate antibiotics, when needed.

I hope this helps clear things up.

Robert Pincus MD

Co-Director NY Sinus Center

Associate Professor Otolaryngology, NY Medical College

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 constant nasal pressure, difficulty breathing through my nose and a bad odor

Question:

Why do I have a constant pressure from top to bottom of my nose? Also difficulty breathing sometimes with mouth closed.  I also think that there is odor from my sinus.

Answer:

Thanks for your question.  While it is impossible to say for sure from your description, it is quite likely that you have a sinus infection.  Sinuses are spaces around the nose that make mucous and drain into the nose.  If the sinus openings get blocked, the mucous cannot drain and one tends to get a secondary bacterial infection.  This can feel like a pressure sensation.   The swelling of the lining of the nose makes it difficult to breathe freely through the nasal passageways.  Bacteria growing in the closed environment of the blocked sinuses can make pus which will have a bad odor.

These are 3 of the cardinal signs of a sinus infection.

This is the section from our website www.nysinuscenter.com that describes the symptoms of a chronic sinus infection.

Symptoms of Chronic Sinusitis

Sinusitis usually causes nasal stuffiness and a feeling of pressure or pain in the face and head. It often causes a thick discolored nasal discharge, cough, even severe asthma, loss of ability to taste and smell, pain in the upper teeth, bad breath, a generalized feeling of fatigue and feeling sick. If you are experiencing any or all of these symptoms, a doctor’s evaluation can help determine the underlying cause. Contact us today for an appointment.

I would suggest you have a medical evaluation by a sinus specialist either here at the sinus center or near you if you’re not in the NY area.

I hope this clears things up.

Robert Pincus MD

C0-Director NY Sinus Center

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