I have had a ear/sinus infection for 5 months. I believe the cause was
a small tear in the tympanic membrane during scuba diving and a 2 week
case of the flu immediately after. The tear has healed itself. I have
been on antibiotics for 4 months (Amoxicillin, Biaxin, Suprax, Sulfamet,
Augmentin) along with Prednisone and Nasacort. I have not been on any
antibiotics the last month. The ENT did a CT scan and says that the
drainage paths for the maxillary sinus' are narrow and the mucus membranes
are thickened. There is also swelling in the smell tissues. He wants to
enlarge the openings, remove the wall of a "gutter" and remove the ethmoid
sinus'.
He was good about explaining the surgery but I wonder if this is really
necessary. Is there a less intrusive procedure to clear up the infection?
I have never had problems with alergies or ear/sinus infections before.
I would also like to know if the surgery will prevent scuba diving in the
future. I have been diving since the tear occurred and had no problem
equalizing the pressure in my ears.
Answer ----------------------
Your post does not describe any symptoms that you might be presently experiencing. Certainly a history of bothersome sinus symptoms such as facial pain or pressure, post-nasal drainage, alteration in the senses of taste and smell, nasal obstruction, fatigue,etc. that have been persistent for several months and that have failed to respond to long-term antibiotic therapy adjunctive systemic and topical steroids, as well as allergy and environmental management, would most likely warrant consideration of surgical intervention if supported by radiographic findings seen on a CT scan. It is very important however, to consider any x-ray abnormalities in context with the actual symptoms that a patient experiences. The persistence of bothersome symptoms is a more important surgical criterion than x-ray findings alone.
Assuming that you do indeed have persistent bothersome symptoms, and considering the abnormal x-ray findings, and the medical therapies noted in the information provided, sinus surgery to improve ventilation of the sinuses and to relieve any physiological obstruction to the normal drainage pathways appears to be an appropriate next step.
Current "state of the art" methods designed to surgically restore normal
function to the sinuses involve the use of endoscopes and rely heavily on
contemporary understanding of the normal physiology of the membranes which
line the sinus cavities and the natural drainage patterns of mucous produced
by that lining.
This type of surgery is considered "functional" and differs from older
methods of surgical intervention for sinus disease known as "open" techniques
which are more "radical" and are designed to convert the sinuses into large
open cavities which often causes significant alterations in the natural flow
of mucous produced in the sinuses. The newer endoscopic techniques of sinus
surgery focus on improving the patency of the normal drainage channels and
attempt to avoid widespread surgical manipulation of the sinuses. The
expectation is that improvement of the natural sinus drainage pathways and,
therefore, improvement in sinus ventilation will allow diseased mucosal
lining within the sinuses to return to normal.
There is no reason to anticipate that undergoing endoscopic sinus surgery would prevent future scuba diving activity. However, I frequently advise against either scuba diving or airplane travel for several weeks following sinus surgery to allow for proper healing to occur.
--
Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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