I have been experiencing sinus infections which require antibiotic treatments for an average of 8 mos. out of every 12 for the past 2 years. Lately when the treatment runs out, the symptoms return within 2-3 days. Puffiness under the eyes, headadches, slight fever, fatigue, draindage. Augmentin 500 mg 3x/day for 10 day stretches have been the rule. A recent visit to an ENT resulted in a CAT scan which showed a cyst in the r maxillary but no other problems there (but that's where the pressure is.) and a narrowing above the nose with a 's' curve in that area. Slight headache and pressure there, but mostly under the eyes. The confusing thing here is some recent (3-4 weeks old) pain in the center back of the upper neck- as if there is some fluid or pressure there which acts like a stiff neck. The pain radiates down to my upper shoulder muscles and causes an uncomfortabe feeling. Initial ENT exam claims no trouble with ears either, except that every time I swallow, both of my ears 'crackle' inside. There is also a marked tenderness behind the ears joining the pain down the back of my neck and upper shoulders. Hot showers seem to help this tightness and discomfort, but only temporarily. Could this be going on too long and causing infections/ menegitis type problems, and if so would a cat scan show that ? Would an MRI be helpful. Thank you for your excellent topics and discussions.
Reply -----------------------------
The symptoms you describe are all consistent with chronic sinusitis despite
the minimal findings on your CT scan. I suspect that the various pain
symptoms you describe could be secondary to chronic sinusitis as well,
however they are not strongly suggestive of a central nervous system
complication of sinusitis such as meningitis. Pain referred to various
locations in the head and neck area (including the muscles of the head
and neck) is not uncommon in sinusitis. This is simply related to the
complicated pathways of nerves in the head and neck.
Concievably your condition may be related to ineffective ventilation of
the sinuses because of relative anatomical obstruction to the
normal drainage channels of the sinuses. Such obstruction can lead to a
variation of chronic sinusitis which is essentially recurring acute sinusitis.
Recurrent acute sinusitis generally refers to frequent short term sinus
infections which usually respond to one or two course of antibiotics, with
the infections recurring several times throughout the year, and with few
findings seen on x-rays such as CT scans. Medical intervention designed to
prevent the recurrences is generally directed at identifying any immune or
allergic factors as well as improving the ventilation and drainage of the
sinuses.
Outside of allergy management, this usually requires the regular use of
topical nasal steroid sprays (Vancenase, Rhinocort, Nasacort, Flonase, etc.)
and mucolytic agents such as guaifenesin, possibly in combination with systemic
decongestant (pseudoephedrine, etc.). When recurrent infections persist
despite appropriate medical therapy, limited sinus surgery (endoscopic sinus
surgery) is often recommended to surgically improve the natural drainage
pathways.
MRI scans are not the preferred method of examining the sinuses
radiographically.
CT scans are the preferred approach since they provide detailed images
of the bony anatomy of the sinuses.
--
Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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