I try to be brief. I have 5- 6 sinus infections, documented a year. This last one has lasted 8 weeks. I have been on Trimeth-Sulfa, Suprax and two course of Flagly as well as Prednisone and Benconaise (sp?) Finally partway into the first course of Flagly my GP send me to an ENT. He did an endoscopy, I think, in his often, numbed my nose and put a probe up there and said it would be helpful to irrigate my left max. sinus. I consented. Hated it and he got nothing out of there. I had 2 prior xrays showing complete opacification of the left max and mucosu (sp?) thickening of the right. Pain has been my upper teeth for 8 weeks and a constant headache across my forehead and between my eyes this whole time. I also have common chronic migraines which have been in almost complete remission thanks to propanolol. However, this last 8 weeks has been hell with constant headaches and them triggering my migraines.
Today I had a ct scan and I looked at the screen afterwards, much to the dismay of the tech. Anyway. My sphenoid sinus were completely different shapes the left was almost double the size of the right and had a much more irregular shape. My Max sinus looked ok except the left that had a large white chunk missing from the lower portion (soft tissue) or whatever. I assumed the black on the screen indicated air, lack of tissue/substance. Anyway what can I expect next? My doc is out of the country for 2 weeks so have to wait that long for any official word. Is it normal to have sinuses of two different sizes or shapes? I did not see my frontal or ethmoid which have been very painful. The tech scooted me out of there as quick as possible. Thanks in advance.... anxious to hear something.
Reply ----------------------------
The description of your symptoms and x-ray findings are all consistent with a diagnosis of chronic sinusitis that has failed to respond to medical therapy. First of all, asymmetry of the sinuses, particularly the frontal sinuses (located in the forehead) and the sphenoid sinuses (located in the center of the skull), is extremely common and not clinically significant.
As you have deduced, black indicates the presence of air in a CT scan of the sinus. Opacifications of the sinus can be caused by fluid such as pus, thickening of the mucous membrane lining of the sinuses, polyps, or rarely tumors. The area of greatest concern to the ENT specialist is known as the ostiomeatal complex, which is an area in the ethmoid sinuses which are located essentially between the eyes. It is in this location that there is a common channel through which the majority of the sinuses drain. Radiographic evidence of obstruction in this area seen after long-term medical therapy, when symptoms characteristic of inflammatory sinus disease are present (such as those you describe) usually represent an appropriate indication to pursue surgical intervention to restore normal drainage to the sinuses.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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