Dear Doctor, My doctor has twice in six months sent me to MRI's for nasal
congestion. Isn't that a bit much? The magnetic fields must be terrible.
I find that when I sniff non-iodide salt in warm water, or apply hot-cold
compresses, or avoid drinking too much wine that my stuffiness almost
disappears. Also, flonase has proved wonderful. How long can one use that
spray?--I notice that I don't smell or taste as well with it, but it
certainly relieves stuffiness. Thanks. !
Reply: -------------------------
MRI scans are not felt to be the optimal method of imaging the sinuses in the evaluation of chronic sinusitis. This is because they tend to be far too sensitive - relatively asymptomatic patients in the winter months are commonly found to have swollen sinus membranes on MRI scans. MRI scans also do not show bone and it is necessary to see the bony detail of the sinus drainage pathways when assessing chronic sinusitis. Therefore, CT scans are the imaging modality of choice when it is necessary to do an X-ray of the sinuses in the evaluation of chronic sinusitis that does not seem to be responding appropriately to medical therapy.
The other issue is when are sinus X-rays necessary. If the primary symptom you have is simply a stuffy nose, then 2 MRI scans (or CT scans) in 6 months would certainly seem excessive. Most of the time, CT scans of the sinuses are ordered to a) make or confirm the diagnosis of sinusitis or b) to help guide therapy in chronic sinusitis. It is generally not difficult for physicians to diagnose sinusitis, and therefore it is uncommon to need a CT scan for that purpose. It is much more common to obtain a CT scan in the assessment of an individual who suffers from chronic sinus symptoms despite comprehensive medical evaluation and therapy. Sinus CT scans in this situation are usually used to determine whether or not surgical therapy might be indicated and therefore such CT scan assessment is usually not performed until relatively long-term therapy (weeks to months) has been completed.
As to your final question regarding the safety of long term use of nasal steroids - when used in recommended dosages, commonly prescribed nasal steroid sprays are considered very safe for long term use. In fact, they are typically meant to be used in this fashion. The dosages of such sprays are small and result in negligible amounts of the medication entering the circulation with the main effect occuring in the nasal and sinus membrane. Nasal steroid sprays typically do not result in dramatic improvement in symptoms in the short run - usually regular use for 72 hours to a week or more is necessary before symptoms significantly improve. A recent study has suggested that topical nasal steroids when used in high doses over long periods of time may cause ophthalmic problems so their use should be limited to the recommended dosages.
--
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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