Radiology - Sinus CT Scan

Author

Sinus CT Scan - Pictures

Michael Wilson III

2006-02-25, 8:54 pm

I got a sinus cat scan because of constant pressure above the roof of my
mouth. I am not sure if the radiologist looked at it, and if they did they
did not give their impressions. I received a disc with the images, however.
My appointment with the ENT to get diagnosed is not for another week, and I
am getting very anxious to know the results. Could anyone provide some
insight? Here are the images (use Page Up and Page Down keys to flip
through):

http://home.comcast.net/~mike5566/

All standard disclaimers apply, I know not to trust advice given on the
internet, etc. This is only to ease my mind until my appointment with the
ENT.

P.S. Tilt was -21.5 degrees, if that helps any.

Ray Laughton

2006-02-25, 8:54 pm

Michael Wilson III <mike5566@REMOVETHIScomcast.net> wrote:

> I got a sinus cat scan because of constant pressure above the roof of my
> mouth. I am not sure if the radiologist looked at it, and if they did they
> did not give their impressions. I received a disc with the images, however.
> My appointment with the ENT to get diagnosed is not for another week, and I
> am getting very anxious to know the results. Could anyone provide some
> insight? Here are the images (use Page Up and Page Down keys to flip
> through):
>
> http://home.comcast.net/~mike5566/
>
> All standard disclaimers apply, I know not to trust advice given on the
> internet, etc. This is only to ease my mind until my appointment with the
> ENT.

Pansinusitis, left>re.
The mucus membranes in your left nasal cavity also quite swollen, you
probably have a cold.

tyshock

2006-02-25, 8:54 pm

>From an absolute layman's perspective---------

On 0032 and 0033, your lower septum looks deviated to the left. This
may be contributing to the bad swelling on the left side. It also
looks like something is going on in the left maxillary. Do you have
tooth pain in your left upper teeth (molar region)? The left ethmoids
also looked like a bit of something was going on. To what degree, i
don't know. The ethmoids are hard to judge for this layman.

Steven L.

2006-02-25, 8:54 pm

Michael Wilson III wrote:

> I got a sinus cat scan because of constant pressure above the roof of my
> mouth. I am not sure if the radiologist looked at it, and if they did they
> did not give their impressions. I received a disc with the images, however.
> My appointment with the ENT to get diagnosed is not for another week, and I
> am getting very anxious to know the results. Could anyone provide some
> insight? Here are the images (use Page Up and Page Down keys to flip
> through):
>
> http://home.comcast.net/~mike5566/
>
> All standard disclaimers apply, I know not to trust advice given on the
> internet, etc. This is only to ease my mind until my appointment with the
> ENT.

[Disclaimer: I'm NOT a doctor or radiologist, just a patient who's been
there, done that]

What I see looks like sinusitis, particularly on your left side. The
rule of thumb is that the black areas represent wide open space (which
is what you want to have in your sinuses); the white/light-gray areas
represent tissue or fluid (which you don't want filling up your
sinuses). So what I see is:

Left ethmoid sinuses whose ducts are almost completely blocked by polyps
and cysts.
Significantly thickened sinus linings suggestive of inflammation and
perhaps infection.
And you've got a large polyp in your left maxillary sinus, which I think
is blocking the duct from draining.
Your right side doesn't look too bad though.
You have a deviated septum, but it's not as deviated as mine was.

From this CT scan , I'll bet your symptoms are mostly on your left
side--feeling of stuffiness, particularly above the left side of the
bridge of your nose.

--
Steven D. Litvintchouk
Email: sdlitvin@earthlinkNOSPAM.net

Remove the NOSPAM before replying to me.

Michael Wilson III

2006-02-25, 8:54 pm

"Steven L." <sdlitvin@earthlinkNOSPAM.net> wrote in message
news:ZgrEf.4826$Nv2.3290@newsread1.news.atl.earthlink.net...
> Michael Wilson III wrote:
>
they[vbcol=seagreen]
however.[vbcol=seagreen]
and I[vbcol=seagreen]
the[vbcol=seagreen]
>
> [Disclaimer: I'm NOT a doctor or radiologist, just a patient who's been
> there, done that]
>
> What I see looks like sinusitis, particularly on your left side. The
> rule of thumb is that the black areas represent wide open space (which
> is what you want to have in your sinuses); the white/light-gray areas
> represent tissue or fluid (which you don't want filling up your
> sinuses). So what I see is:
>
> Left ethmoid sinuses whose ducts are almost completely blocked by polyps
> and cysts.
> Significantly thickened sinus linings suggestive of inflammation and
> perhaps infection.
> And you've got a large polyp in your left maxillary sinus, which I think
> is blocking the duct from draining.
> Your right side doesn't look too bad though.
> You have a deviated septum, but it's not as deviated as mine was.
>
> From this CT scan , I'll bet your symptoms are mostly on your left
> side--feeling of stuffiness, particularly above the left side of the
> bridge of your nose.
>
>
> --
> Steven D. Litvintchouk
> Email: sdlitvin@earthlinkNOSPAM.net
>
> Remove the NOSPAM before replying to me.

I called today and found out that the radiologist did in fact give
impressions, I just needed to go and pick them up. Here they are:

http://home.comcast.net/~mike5566/impressions.html

I'm not sure what any of that means, but I'm very relieved to know I'm not
imagining it. This has been going on for several years, a feeling of
pressure behind my nose and above my left molars. I had gotten tested for
TMJ, had an MRI done on my brain, and gotten a laryngoscopy, none of which
showed any problems.

Thanks to all who took the time to respond, it is nice to have a second
opinion.

Murray Grossan

2006-02-25, 8:54 pm

On 2/2/06 5:28 AM, in article 1ha4ypo.1w02qhj1721d4wN%rlaughton@invalid.com,
"Ray Laughton" <rlaughton@invalid.com> wrote:

> Michael Wilson III <mike5566@REMOVETHIScomcast.net> wrote:
>
>
> Pansinusitis, left>re.
> The mucus membranes in your left nasal cavity also quite swollen, you
> probably have a cold.

Doesn't look too bad, looks like the kind tha clears with medication.

Don Brady

2006-02-25, 8:54 pm

A caution is in order.

The radiologist's report and the informal comments here are just a rough
starting point - they are not medical opinions.

A medical opinion can only given when the sinus specialist studies the original
images in connection with an endoscopic exam.

Ray Laughton

2006-02-25, 8:54 pm

Don Brady <dbrady@pobox.com> wrote:

> A caution is in order.
Always a good idea.

> The radiologist's report and the informal comments here are just a rough
> starting point - they are not medical opinions.
Gee thanks for cutting me some slack here. :-/

> A medical opinion can only given when the sinus specialist studies the
> original images in connection with an endoscopic exam.

Huh?
Do you really think one can only diagnose a sinusitis by endoscopy?
Normally a simple x-ray is sufficient.
We're talking about a simple infection or inflammation of the sinuses
here, not cancer. CT is already over-the-top as far as rad. dose to the
lenses go, it should be reserved for difficult cases.
If the sinusitis doesnt improve after treatment THEN the endoscopy and
maybe the CT is justified, both time-wise and radiation-wise.

RL

Ray Laughton

2006-02-25, 8:54 pm

Michael Wilson III <mike5566@REMOVETHIScomcast.net> wrote:

> I called today and found out that the radiologist did in fact give
> impressions, I just needed to go and pick them up. Here they are:
>
> http://home.comcast.net/~mike5566/impressions.html
>
> I'm not sure what any of that means, but I'm very relieved to know I'm not
> imagining it.
LOL! But I'm surprised they missed the sinus problem in the MRI, its
usually visible there too.
> This has been going on for several years, a feeling of
> pressure behind my nose and above my left molars. I had gotten tested for
> TMJ, had an MRI done on my brain, and gotten a laryngoscopy, none of which
> showed any problems.
>
> Thanks to all who took the time to respond, it is nice to have a second
> opinion.

Yea, well mine was short, sweet and understandable. As I recall there
were also problems with your teeth (malocclusion) which I'm sure you
know about and a slight septum deviation but I understood your sinuses
were the problem so I concentrated on them.
A page of gobbledy-gook and no diagnosis are OK - (well, understandable)
when you're being paid by the hour and half a dozen lawyers are
breathing down your back. I sorta feel sorry for my yank colleagues, all
the Porsches in the world dont make up for the way they have to work.

Ray

BTW - Did you have a cold when you went for the CT?

Steven L.

2006-02-25, 8:54 pm

Ray Laughton wrote:

> Don Brady <dbrady@pobox.com> wrote:
>
>
>
> Always a good idea.
>
>
>
> Gee thanks for cutting me some slack here. :-/
>
>
>
>
> Huh?
> Do you really think one can only diagnose a sinusitis by endoscopy?
> Normally a simple x-ray is sufficient.

For sinusitis, the percentage of false positive results from X-rays is
known to be roughly around 40%, compared with around 10% for CT scans.

medind.nic.in/ibd/t04/i1/ibdt04i1p9o.pdf

> If the sinusitis doesnt improve after treatment THEN the endoscopy and
> maybe the CT is justified, both time-wise and radiation-wise.

In today's managed care, patients typically get referred to ENTs only
after multiple courses of antibiotics and steroids have failed.

--
Steven D. Litvintchouk
Email: sdlitvin@earthlinkNOSPAM.net

Remove the NOSPAM before replying to me.

Ray Laughton

2006-02-25, 8:54 pm

Steven L. <sdlitvin@earthlinkNOSPAM.net> wrote:

> Ray Laughton wrote:
>
>
> For sinusitis, the percentage of false positive results from X-rays is
> known to be roughly around 40%, compared with around 10% for CT scans.
Probably because so few radiologists get to see them anymore..
> medind.nic.in/ibd/t04/i1/ibdt04i1p9o.pdf
>
>
>
> In today's managed care, patients typically get referred to ENTs only
> after multiple courses of antibiotics and steroids have failed.
It'll pass. We're only beginning to find out the long-term effects of
all this AB use in kids. As for steroids in kids, or steroids for adult
sinusitis that matter.... ridiculous.

RL

Don Brady

2006-02-25, 8:54 pm

On Fri, 3 Feb 2006 19:03:19 +0100, rlaughton@invalid.com (Ray Laughton) wrote:

>Don Brady <dbrady@pobox.com> wrote:
>
>Always a good idea.
>
>Gee thanks for cutting me some slack here. :-/

Oh I was not directing my comments at your posts at all.

>
>
>Huh?
>Do you really think one can only diagnose a sinusitis by endoscopy?
>Normally a simple x-ray is sufficient.
>We're talking about a simple infection or inflammation of the sinuses
>here, not cancer

How are your ever 100% sure until you examine the patient?

>. CT is already over-the-top as far as rad. dose to the
>lenses go, it should be reserved for difficult cases.
>If the sinusitis doesnt improve after treatment THEN the endoscopy and
>maybe the CT is justified, both time-wise and radiation-wise.
>

I was not advocating the CT. It was already done. I was just saying do not
rely on it *alone* until the physician sees it and interprets in conjunction
with a nomal clinical visit and pateint history.

Nasal endoscopy is done routinely now. Pehaps you have experience in other
fields where it is more difficult? In any case, I was just using it as an
example of something that would be done by the physician, that the radiologist
cannot do.

I was mostly just talking about terminology, in case the original poster
thought (or was that you - I have lost track) he was done now.

Steven L.

2006-02-25, 8:54 pm

Michael Wilson III wrote:

> "Steven L." <sdlitvin@earthlinkNOSPAM.net> wrote in message
> news:ZgrEf.4826$Nv2.3290@newsread1.news.atl.earthlink.net...
>
>
> they
>
>
> however.
>
>
> and I
>
>
> the
>
>
>
> I called today and found out that the radiologist did in fact give
> impressions, I just needed to go and pick them up. Here they are:
>
> http://home.comcast.net/~mike5566/impressions.html
>
> I'm not sure what any of that means, but I'm very relieved to know I'm not
> imagining it. This has been going on for several years, a feeling of
> pressure behind my nose and above my left molars. I had gotten tested for
> TMJ, had an MRI done on my brain, and gotten a laryngoscopy, none of which
> showed any problems.
>
> Thanks to all who took the time to respond, it is nice to have a second
> opinion.

I think you should make sure that your ENT looks at these films himself,
and doesn't rely on the radiologist's opinion alone. I'm more
interested in what your ENT has to say than what the radiologist has to
say. Because your ENT can combine what he sees on the CT scan with
everything else he knows about you--patient history, other tests--to
make a more precise diagnosis.

--
Steven D. Litvintchouk
Email: sdlitvin@earthlinkNOSPAM.net

Remove the NOSPAM before replying to me.

richard.epstein@alum.mit.edu

2006-02-25, 8:54 pm

The images you posted do not have Left and Right labeled. They were
obtained coronally, presumably with you laying on your stomach with
your chin up. Most CT scanners "flip" the images in that case. Based on
the reading by the Radiologist, the images are indeed "flipped". When
printed out, the images would normally be as if you were looking at the
patient (the patient's left is on your right). Since they were not
flipped in your jpeg images, the patient's left is on your left.
Therefore, you have more mucosal thickening in your RIGHT maxillary
sinus, not your left.

To respond to multiple prior posts, the Radiologist is a doctor. His or
her reading is correct and appropriate. It is not "gobbledy-gook". It
is appropriate communcation between him/herself and the ordering
physician. Most ENT's will also look at the images themselves. "A
picture is worth a thousand words."

An MRI of the brain is not an MRI of the sinuses. While the sinuses are
sometimes seen on an MRI of the brain, they are not evaluated in detail
and would not usually be commented on, except where there are striking
abnormalities. MRI is in general very tailored to the body part in
question. For instance a foot and an ankle are two totally different
studies in MRI.

If your ENT wants an MRI of the sinuses, they could of course order
one. However, CT is usually the preferred test, and for most people,
MRI would not add anything.

-Rich

2006-02-25, 8:54 pm

If I may just comment on two points...

First, there are normal vasoactive changes in the sinonasal mucosa, meaning
that it is normal to have the mucosa on one side slightly thicker than the
other, and this is cyclical throughout the day. Had your CT been done an
hour later, it might have been the other side. It does not mean that you had
a cold on that particular day.

Second, while the attention as been focused on the sinus, your symptoms
regard the roof of the mouth. There is a small, but IMHO abnormal bony
overgrowth, in the anterior midline portion of the hard palate. You may want
to do a google search on torus palatinus.

That's just my 2c.

K.

"Michael Wilson III" <mike5566@REMOVETHIScomcast.net> wrote in message
news:IuqdnQBQh56IC3zeRVn-oQ@comcast.com...
>I got a sinus cat scan because of constant pressure above the roof of my
> mouth. I am not sure if the radiologist looked at it, and if they did they
> did not give their impressions. I received a disc with the images,
> however.
> My appointment with the ENT to get diagnosed is not for another week, and
> I
> am getting very anxious to know the results. Could anyone provide some
> insight? Here are the images (use Page Up and Page Down keys to flip
> through):
>
> http://home.comcast.net/~mike5566/
>
> All standard disclaimers apply, I know not to trust advice given on the
> internet, etc. This is only to ease my mind until my appointment with the
> ENT.
>
> P.S. Tilt was -21.5 degrees, if that helps any.
>
>

Michael Wilson III

2006-02-25, 8:54 pm

"Ray Laughton" <rlaughton@invalid.com> wrote in message
news:1ha6zn4.10fmxoa1ae95blN%rlaughton@invalid.com...
> Michael Wilson III <mike5566@REMOVETHIScomcast.net> wrote:
>
not[vbcol=seagreen]
> LOL! But I'm surprised they missed the sinus problem in the MRI, its
> usually visible there too.
for[vbcol=seagreen]
which[vbcol=seagreen]
>
> Yea, well mine was short, sweet and understandable. As I recall there
> were also problems with your teeth (malocclusion) which I'm sure you
> know about and a slight septum deviation but I understood your sinuses
> were the problem so I concentrated on them.
> A page of gobbledy-gook and no diagnosis are OK - (well, understandable)
> when you're being paid by the hour and half a dozen lawyers are
> breathing down your back. I sorta feel sorry for my yank colleagues, all
> the Porsches in the world dont make up for the way they have to work.
>
> Ray
>
> BTW - Did you have a cold when you went for the CT?

No, I did not have a cold when I went for the CT. Actually since the onset
of this problem I have had colds very rarely.

Is it normal to have the teeth jutting into the sinuses like mine are? I
thought that looked a bit strange. Also my sinuses looked rather large and
oblong compared to the other ones I saw, but my only comparison is to single
snapshots, not a series. I wish I could get my hands on some other CT series
to get a better feel for what is normal. Maybe I will ask a professor at one
of the local med schools.

What do you mean by malocclusion? I had braces when I was younger and have
worn my retainer faithfully since then. But I haven't been back to the
orthodontist for a checkup in a long time, perhaps it's time to schedule
one.

Ray Laughton

2006-02-25, 8:54 pm

Don Brady <dbrady@pobox.com> wrote:

> On Fri, 3 Feb 2006 19:03:19 +0100, rlaughton@invalid.com (Ray Laughton) wrote:
>
>
> Oh I was not directing my comments at your posts at all.
>
>
> How are your ever 100% sure until you examine the patient?
Well I learnt this stuff in the country hospital setting, where one can
still chat with the patients.. The X-ray alone is too little. Of course
if the referring colleague has take the time to include a good history
then its easy.

>
> I was not advocating the CT. It was already done.
I realize that, you were advocating the endoscopy.

> I was just saying do not
> rely on it *alone* until the physician sees it and interprets in conjunction
> with a nomal clinical visit and pateint history.
See above

> Nasal endoscopy is done routinely now. Pehaps you have experience in other
> fields where it is more difficult? In any case, I was just using it as an
> example of something that would be done by the physician, that the radiologist
> cannot do.
It was a few years ago, nasal endoscopies were not routine (in fact they
were quite traumatic and thus seldom used) in that setting. The
radiologist diagnosed, his words were chiselled into stone and formed
the basis of the therapy. We were the diagnostic gods.. :-/
Nowdays all you get from them are 'impressions', it seems (do they train
in art galleries?)

Ray

Ray Laughton

2006-02-25, 8:54 pm

Michael Wilson III <mike5566@REMOVETHIScomcast.net> wrote:

> "Ray Laughton" <rlaughton@invalid.com> wrote in message
> news:1ha6zn4.10fmxoa1ae95blN%rlaughton@invalid.com...
> not
> for
> which
>
> No, I did not have a cold when I went for the CT. Actually since the onset
> of this problem I have had colds very rarely.
Well you must have had a 'stuffy' feeling in the left nostril that day,
the air spaces are minimal..

> Is it normal to have the teeth jutting into the sinuses like mine are? I
> thought that looked a bit strange.
Lets say its not unusual, the upper molar roots on both sides go quite
far in. As long as you prevent an infection getting to the roots of the
teeth and avoid taking a right hook on the jaw, ie no trauma you'll be
ok.. :-/

> Also my sinuses looked rather large and
> oblong compared to the other ones I saw, but my only comparison is to single
> snapshots, not a series. I wish I could get my hands on some other CT series
> to get a better feel for what is normal. Maybe I will ask a professor at one
> of the local med schools.
No need, all your sinuses are normally formed.

> What do you mean by malocclusion? I had braces when I was younger and have
> worn my retainer faithfully since then. But I haven't been back to the
> orthodontist for a checkup in a long time, perhaps it's time to schedule
> one.
Well, this is getting out of my field but your upper jaw is wider than
the the lower jaw. On the left (assuming standard projection) the
upper/lower teeth almost missed each other on some photos, AFAIR.

Ray

Ray Laughton

2006-02-25, 8:54 pm

K. <notavalid@address.com> wrote:

> If I may just comment on two points...
>
> First, there are normal vasoactive changes in the sinonasal mucosa, meaning
> that it is normal to have the mucosa on one side slightly thicker than the
> other, and this is cyclical throughout the day. Had your CT been done an
> hour later, it might have been the other side. It does not mean that you had
> a cold on that particular day.
I was just curious, he must at least had a 'stuffy nose' feeling on the
left that day (assuming standard projection of the images).

> Second, while the attention as been focused on the sinus, your symptoms
> regard the roof of the mouth. There is a small, but IMHO abnormal bony
> overgrowth, in the anterior midline portion of the hard palate. You may want
> to do a google search on torus palatinus.
If its a torus then its at an early stage. Certainly not the cause of
the symptoms which the OP stressed were _above_ the palate.

> That's just my 2c.
this makes it 4c.

Ray[vbcol=seagreen]
>
>
> "Michael Wilson III" <mike5566@REMOVETHIScomcast.net> wrote in message
> news:IuqdnQBQh56IC3zeRVn-oQ@comcast.com...

Ray Laughton

2006-02-25, 8:54 pm

<richard.epstein@alum.mit.edu> wrote:

> The images you posted do not have Left and Right labeled. They were
> obtained coronally, presumably with you laying on your stomach with
> your chin up. Most CT scanners "flip" the images in that case. Based on
> the reading by the Radiologist, the images are indeed "flipped". When
> printed out, the images would normally be as if you were looking at the
> patient (the patient's left is on your right). Since they were not
> flipped in your jpeg images, the patient's left is on your left.
> Therefore, you have more mucosal thickening in your RIGHT maxillary
> sinus, not your left.
Um, his problems are mainly left-sided..
The report also noted the anomalies were mainly on the left.

> To respond to multiple prior posts, the Radiologist is a doctor.
Right, so what else is new..?
> His or her reading is correct and appropriate. It is not "gobbledy-gook".
> It is appropriate communcation between him/herself and the ordering
> physician.
Then this communication should be privy to those individuals and not
handed to the patient or placed on the internet for discussion.
In the time it takes for a lay-person to find out what its all about he
could be half-way through treatment for his sinusitis..

>Most ENT's will also look at the images themselves. "A picture
> is worth a thousand words."
But only to those who understand what they see..

> An MRI of the brain is not an MRI of the sinuses. While the sinuses are
> sometimes seen on an MRI of the brain, they are not evaluated in detail
> and would not usually be commented on, except where there are striking
> abnormalities. MRI is in general very tailored to the body part in
> question.
The report may be, but the imaging is not so selective.. Which is what I
meant. Had there been something abnormal in the sinuses that are often
imaged with the brain (sphenoid, ethmoids, frontal) then I'm sure it
would have been commented on.

> For instance a foot and an ankle are two totally different
> studies in MRI.
>
> If your ENT wants an MRI of the sinuses, they could of course order
> one. However, CT is usually the preferred test, and for most people,
> MRI would not add anything.

I'm sure its not needed, the CT imaging was quite informative. :-/
If easily available I'd rather use the MRI than CT in pediatric sinuses
though..

Ray

Michael Wilson III

2006-02-25, 8:54 pm

"Ray Laughton" <rlaughton@invalid.com> wrote in message
news:1hac5ax.1hh1k4s1icdse4N%rlaughton@invalid.com...
> Michael Wilson III <mike5566@REMOVETHIScomcast.net> wrote:
>
I'm[vbcol=seagreen]
tested[vbcol=seagreen]
second[vbcol=seagreen]
understandable)[vbcol=seagreen]
all[vbcol=seagreen]
onset[vbcol=seagreen]
> Well you must have had a 'stuffy' feeling in the left nostril that day,
> the air spaces are minimal..
>
> Lets say its not unusual, the upper molar roots on both sides go quite
> far in. As long as you prevent an infection getting to the roots of the
> teeth and avoid taking a right hook on the jaw, ie no trauma you'll be
> ok.. :-/
>
single[vbcol=seagreen]
series[vbcol=seagreen]
one[vbcol=seagreen]
> No need, all your sinuses are normally formed.
>
have[vbcol=seagreen]
> Well, this is getting out of my field but your upper jaw is wider than
> the the lower jaw. On the left (assuming standard projection) the
> upper/lower teeth almost missed each other on some photos, AFAIR.
>
> Ray

My appointment with the ENT isn't until tomorrow. But for the past week I've
been taking Rhinocort and Sudafed. They seemed to help at first but have
since stopped working, even after upping the dose.

Two nights ago I started doing salt water rinses, they reduce the sinus
pressure and also give me a slight mood lift??? Unfortunately the
improvement is short lived and I experienced a bad rebound effect several
hours afterwards where the pressure grows much stronger. I gave it one last
try tonight adding a few ml of hydrogen peroxide to the salt water. Overall
the results were the same.

One thing I noticed with the rinses was an ammonia smell. I thought it must
be impurities in the salt, but using the "no preservatives" saline spray
from the pharmacy produced the same results, as did adding hydrogen peroxide
to the mix. There are plenty of other people who have posted this problem
but no one seems to know what is causing it. The only suggestion offered up
is an excess of baking soda, but I didn't use any baking soda. My guess is
that the infection is caused by anaerobic bacteria, many of which produce
ammonia. It's far fetched I know, but either way I want to get on an
antibiotic. Since this problem began five years ago I have taken antibiotics
a total of once, when I had my wisdom teeth removed. I remember it being a
good few days but the painkillers were surely responsible for much of that.

Ray Laughton

2006-02-25, 8:54 pm

Michael Wilson III <mike5566@REMOVETHIScomcast.net> wrote:

> My appointment with the ENT isn't until tomorrow. But for the past week I've
> been taking Rhinocort and Sudafed. They seemed to help at first but have
> since stopped working, even after upping the dose.
>
> Two nights ago I started doing salt water rinses, they reduce the sinus
> pressure and also give me a slight mood lift??? Unfortunately the
> improvement is short lived and I experienced a bad rebound effect several
> hours afterwards where the pressure grows much stronger. I gave it one last
> try tonight adding a few ml of hydrogen peroxide to the salt water. Overall
> the results were the same.
>
> One thing I noticed with the rinses was an ammonia smell. I thought it must
> be impurities in the salt, but using the "no preservatives" saline spray
> from the pharmacy produced the same results, as did adding hydrogen peroxide
> to the mix. There are plenty of other people who have posted this problem
> but no one seems to know what is causing it. The only suggestion offered up
> is an excess of baking soda, but I didn't use any baking soda. My guess is
> that the infection is caused by anaerobic bacteria, many of which produce
> ammonia. It's far fetched I know, but either way I want to get on an
> antibiotic. Since this problem began five years ago I have taken antibiotics
> a total of once, when I had my wisdom teeth removed. I remember it being a
> good few days but the painkillers were surely responsible for much of that.

I'm familiar with the rebound effect from Sudafed but not from salt
water rinses.. The smell (or illusion of it) is probably related to your
sinus problem, not the rinses. Maybe the ENT guy will do an endoscopy,
at the same time he could drain any free fluid that might be in there
now (in the CT there was none). If things look serious he could do a
biopsy, also he could apply medication directly into the maxilliary
sinuses. OTOH a course of antibiotics is the way to go if none have been
used yet. ENT is not my field, BTW.

RL

tyshock

2006-02-25, 8:54 pm

Micheal,

How did your ENT appt go?

JPW

2006-02-28, 1:00 am

Rad interpretation
Mild mucosal thickening in the sinuses, the L and R OMU appear open.
Nasal Septal deviation and concha bul.
Relatively mild findings here based on the images!

"Ray Laughton" <rlaughton@invalid.com> wrote in message
news:1hac6r1.xi00v9vusrjfN%rlaughton@invalid.com...[vbcol=seagreen]
> K. <notavalid@address.com> wrote:
>
> I was just curious, he must at least had a 'stuffy nose' feeling on the
> left that day (assuming standard projection of the images).
>
> If its a torus then its at an early stage. Certainly not the cause of
> the symptoms which the OP stressed were _above_ the palate.
>
> this makes it 4c.
>
> Ray

Michael Wilson III

2006-03-22, 3:41 pm

"tyshock" <tyler.schacht@gmail.com> wrote in message
news:1139929110.862550.282190@g44g2000cwa.googlegroups.com...
> Micheal,
>
> How did your ENT appt go?
>

Sorry it took so long to reply. My appointment was fine, he prescribed oral
steroids and a five day course of the antibiotic Ketek (telithromycin). It
seemed to help at first, peaking around 10 days when I began augmenting with
saltwater rinses, and low salt diet + increased water intake (to thin
mucus). But that stopped working shortly after. Now I am back to the usual.
He wanted to do surgery if it failed but first I want to give antibiotics
another try. Plus my appointment isnt't for two more weeks so I have some
time to kill.

Here is what I plan to do for the next two weeks, beginning today.

1. Amoxicillin 1000mg + Clarithromycin 500mg twice daily (google "Prevpac")
2. Grossan Irrigator twice daily.
3. Rhinocort 2 sprays per nostril, twice daily.
4. Steam inhaler once daily.
5. final four days only: Low salt diet + increased water intake
6. final four days only: Afrin 2 sprays per nostril, once daily
7. final four days only: Oral steroids (prednisone) which I have left over.
it was giving me bad side effects so I didn't take all of it.

Disclaimer: Don't try this at home before asking your doctor. I didn't ask
my doctor, but I am reckless and don't particularly care what happens to me.

Murray Grossan

2006-03-22, 3:41 pm

On 3/9/06 2:17 PM, in article tPydnShK9N34NI3ZRVn-gg@comcast.com, "Michael
Wilson III" <mike5566@REMOVETHIScomcast.net> wrote:

>
> "tyshock" <tyler.schacht@gmail.com> wrote in message
> news:1139929110.862550.282190@g44g2000cwa.googlegroups.com...
>
> Sorry it took so long to reply. My appointment was fine, he prescribed oral
> steroids and a five day course of the antibiotic Ketek (telithromycin). It
> seemed to help at first, peaking around 10 days when I began augmenting with
> saltwater rinses, and low salt diet + increased water intake (to thin
> mucus). But that stopped working shortly after. Now I am back to the usual.
> He wanted to do surgery if it failed but first I want to give antibiotics
> another try. Plus my appointment isnt't for two more weeks so I have some
> time to kill.
>
> Here is what I plan to do for the next two weeks, beginning today.
>
> 1. Amoxicillin 1000mg + Clarithromycin 500mg twice daily (google "Prevpac")
> 2. Grossan Irrigator twice daily.
> 3. Rhinocort 2 sprays per nostril, twice daily.
> 4. Steam inhaler once daily.
> 5. final four days only: Low salt diet + increased water intake
> 6. final four days only: Afrin 2 sprays per nostril, once daily
> 7. final four days only: Oral steroids (prednisone) which I have left over.
> it was giving me bad side effects so I didn't take all of it.
>
> Disclaimer: Don't try this at home before asking your doctor. I didn't ask
> my doctor, but I am reckless and don't particularly care what happens to me.
>
>
Why the low salt diet??? What is that supposed to do?

Andrew Kerr

2006-03-22, 3:41 pm

Michael Wilson III wrote:
> "tyshock" <tyler.schacht@gmail.com> wrote in message
> news:1139929110.862550.282190@g44g2000cwa.googlegroups.com...
>
> Sorry it took so long to reply. My appointment was fine, he prescribed oral
> steroids and a five day course of the antibiotic Ketek (telithromycin). It
> seemed to help at first, peaking around 10 days when I began augmenting with
> saltwater rinses, and low salt diet + increased water intake (to thin
> mucus). But that stopped working shortly after. Now I am back to the usual.
> He wanted to do surgery if it failed but first I want to give antibiotics
> another try. Plus my appointment isnt't for two more weeks so I have some
> time to kill.
>
> Here is what I plan to do for the next two weeks, beginning today.
>
> 1. Amoxicillin 1000mg + Clarithromycin 500mg twice daily (google "Prevpac")
> 2. Grossan Irrigator twice daily.
> 3. Rhinocort 2 sprays per nostril, twice daily.
> 4. Steam inhaler once daily.
> 5. final four days only: Low salt diet + increased water intake
> 6. final four days only: Afrin 2 sprays per nostril, once daily
> 7. final four days only: Oral steroids (prednisone) which I have left over.
> it was giving me bad side effects so I didn't take all of it.
>
> Disclaimer: Don't try this at home before asking your doctor. I didn't ask
> my doctor, but I am reckless and don't particularly care what happens to me.
>
>

Why don't you just do what the ENT specialist says without "augmenting"
with any of your own solutions? You said yourself that the prednisone
and antibiotics were helping before you started rinsing.

I suspect that you have chronic sinusitis which you continue to irritate
by rinsing/flushing/spraying various solutions up there. Sometimes your
body just needs to heal.

If you truly "don't particularly care what happens to (you}," then quit
whining and live with it.

I'm not a doctor but I do work in health care and see lots of patients
like you - chronic complainers who simply prefer to complain about their
symptoms rather than follow their doctors advise.

Andrew

Michael Wilson III

2006-03-22, 3:41 pm

"Murray Grossan" <hydromed@adelphia.net> wrote in message
news:C037893F.3A8D%hydromed@adelphia.net...
> On 3/9/06 2:17 PM, in article tPydnShK9N34NI3ZRVn-gg@comcast.com, "Michael
> Wilson III" <mike5566@REMOVETHIScomcast.net> wrote:
>
oral[vbcol=seagreen]
It[vbcol=seagreen]
with[vbcol=seagreen]
usual.[vbcol=seagreen]
antibiotics[vbcol=seagreen]
some[vbcol=seagreen]
"Prevpac")[vbcol=seagreen]
over.[vbcol=seagreen]
ask[vbcol=seagreen]
me.[vbcol=seagreen]
> Why the low salt diet??? What is that supposed to do?
>

Your right, there is no point to the low-sodium diet. It was more of a trial
and error thing at first. Around two days after taking my last antibiotic I
was doing a lot of salt water rinses (this was before I purchased the
Grossan) because initially they made me feel much better, if only for a
short time. Then for no apparent reason things began to worsen, to the point
where I was not getting any sleep whatsoever and feeling like crap. I'm
still not sure why that happened but decided I might be getting too much
sodium. The next day I dramatically increased my fluid intake and lowered
the sodium in my diet. This helped immensely. It could have helped because
of the low sodium diet, the increased fluid intake, or both. But the
following studies lead me to believe it was not the low sodium diet:

http://tinyurl.com/hwks7
http://tinyurl.com/fb374
http://tinyurl.com/h3ew6

I am going to increase both my water and sodium intake to higher than normal
(but not super-high) levels. Chicken soup is basically lots of water and
lots of sodium, right? And doctors always recommend increased fluid intake.
Plus it just makes sense. If my body doesn't want all that sodium or water
it can just excrete it in the urine. But if it needs more, it has no way of
getting it.