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Bloody Nasal Discharge
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Michldon posted:
Hi Dear Doctor,

As the sinus CT scan that order by my primary doctor on 02/09/2009, the result shows:

Findings: The frontal sinuses are hypoplastic. There is mild degree of mucoperiosteal thickening in the ethmoid sinuses, left greater than right. There is extensive opacification of the left maxillary sinus with partial obstruction of the left osteomeatal complex. There is deviation of the nasal septum from left to right.

Impression: Extensive chronic left maxillary sinusitis with obstruction of the osteomeatal complex.

In case my primary doctor recommended me to start using NASONEX and sinus rinse kit to wash my noses.

From 03/12/2009, white & thick & sticky nasal mucus drainage went out from my left nostril with a little bit bright & flash blood-streak.

After the discussion with my primary doctor on 03/24/2009, I stopped using NASONEX and sinus rinse kit because my primary doctor thought Nasonex was a steroid and it could cause thinning of mucosa sometimes to result nose bleed.

However brown & thick & sticky nasal mucus still kept happened with a little bit bright & flash blood-streak from my left nostril after stopped using NASONEX and sinus rinse kit. Also I felt headache & toothache & facial pain on the left side.

On 04/17/2009 (Friday morning), I saw the ENT and he did a nasal endoscopy. He said the nasal structures look normal and there is no sign of inflammation or pus. It was really surprised to me because I found blood-streak in the left nostril with Qtips Thursday night. It is really confused to me why the ENT doctor can?t seeno evidence in the nose of anything going on by endoscopy.

So my question is:

As the result from the previous sinus CT, it shows the left maxillary sinusitis with obstruction only. However as the information from the web site, usually sinusitis won't cause any bloody discharge. From the check by routine nasal endoscopy, the ENT doctor didn't see any blood inside nose/nostrils.

Since brown & thick & sticky nasal mucus with a little blood-streak is still present till now, I am afraid whether there is any tumors or other growths happened inside my nose/sinus. Where does this blood-streak come from? Shall I request new CT scan again? How can I do now?

Please give me your suggestion. Thanks so much for your time.
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Rod_Moser_PA_PhD responded:
I disagree. Blood-tinged mucous is quite common in sinusitis and other nasopharyngeal disorders. The nasal mucosa is VERY vascular and it doesn't take much of an incident, just inflammation, to cause it to bleed slightly. And, yes, one of the side effects of Nasonex is an increase in epistaxis (bleeding from the nose). Since the bleeding sites heal quickly, your ENT may not have been able to determine a particular source. Bleeding in no way implies that you have some sort of occult tumor or cancer. If you did, the sinus CT would have spotted it easily.
 
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Michldon responded:
Dear Doctor,

I am so glad to see your quick assistance and detail explaining.

More questions come out after I read your feedback.

Q1: I am wondering whether any tumors or other growths were happened inside my nose/sinus after my previous sinus CT scan on 02/09/2009 because white/brown & thick & sticky nasal mucus drainage went out from my left nostril with a little bit bright & flash blood-streak from 02/09/2009 to now. Is it possible? Is it necessary for me to re-do new sinus CT again?

Q2: Regarding my bloody nasal discharge till now, I visited my ENT doctor this afternoon. After his study from my previous sinus CT scan and my current symptom, he recommended me to re-start using NASONEX with 2puffs in to each nostril every morning and take one AMOXICILLIN 500MG capsules by mouth three times daily. As his explaining, my bloody nasal discharge will stop within 2 weeks after I take these medicines. Otherwise he might consider doing more exam to check whether any tumors or other growths are happened inside my nose/sinus. Since one of the side effects of Nasonex is an increase in epistaxis (bleeding from the nose), I am really confused how we can use it to stop bloody nasal discharge and why we don't re-do new sinus CT to verify inside my nose/sinus now. Please share me your comments about it.

Q3: As your experience, where could this blood-streak come from? Please give me your advice to stop bloody nasal discharge and treat my extensive chronic left maxillary sinusitis with obstruction of the osteomeatal complex.

Thanks again for your time and patience.

Best Regards
 
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Rod_Moser_PA_PhD responded:
1. It is not very likely that a problematic mass or tumor would suddenly pop up after the CT scan and cause your nose to bleed. CTs are a lot of radiation exposure, so I would not be anxious as a medical provider (or a patient) to do another one so soon.

2. It is difficult for me to specifically comment on your ENTs treatment regime since I do not know the specific details of your case, such as your examination findings, however, I do not really find fault with how he is approaching this issue. I know you are putting a lot of confidence in those CT findings, but I really don't see the necessity to head back to the radiology department at this point. I know you asked your ENT about this point. What did he say?

3. I thought I explained that....so, let me do it again. The nasal mucosa is VERY vascular. It bleeds all of the time, mostly down the back of our throats were we don't see it. Haven't you ever experienced a nose bleed during a cold? Minor nose bleeds -- streaking of blood -- is really not a worrisome symptom to most seasoned medical providers, especially ENTs. I do understand that it is worrisome to you since you feel this finding is the hallmark of something "serious", like a cancer. Again, it would not be very likely that this is the case.

Treating your chronic sinusitis is not an easy job, so expect weeks and weeks of therapy. Sinuses are bony cavities and they can be very tricky to treat. It takes time....
 
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Michldon responded:
Dear Doctor,

Thanks for your kindly help to give me so detail explaining.

Yes, I asked my ENT several times about CT scan. But he always said that we'd better complete this treatment firstly. With your explaining, I got more understanding why my ENT didn't order another CT scan at this moment.

About NASONEX nasal spray, what's the benefit to use this NASONEX since my primary doctor and my ENT both recommended this medicine.

As my previous CT scan report below, it seems I do have chronic left maxillary sinusitis issue. But I am not clear about the other findings in this report. Would you please give me a little more introduction? -------------------------------------------------------------------------------------------------------------------------------------- Findings: The frontal sinuses are hypoplastic. There is mild degree of mucoperiosteal thickening in the ethmoid sinuses, left greater than right. There is extensive opacification of the left maxillary sinus with partial obstruction of the left osteomeatal complex. There is deviation of the nasal septum from left to right.

Impression: Extensive chronic left maxillary sinusitis with obstruction of the osteomeatal complex. --------------------------------------------------------------------------------------------------------------------------------------

I look forward to hearing your comments soon.

Best Regards
 
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Rod_Moser_PA_PhD responded:
I do not like to interpret CT findings without having the corresponding clinical findings from your exam, so I am going to defer that explanation to doctor -- someone that has BOTH of those puzzle pieces. The bottom line, however, is that you have sinusitis. You know that.

Nasonex is an anti-inflammatory -- a steroid spray that will (hopefully) help OPEN those clogged and congested sinuses and allow them to drain. Sometimes it helps...sometimes it does not, so you may have to take it for a few weeks to see what kind of clinical response you get. Trying Nasonex is a lot better than having your ENT stick a needle in there to irrigate the sinuses, or cut a surgical "window" so the sinuses will drain.
 
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Michldon responded:
Dear Doctor,

Thank you so much for your time and patience. I got more understanding now with your detail explaining.

I will come back to discuss with you again if I have any question in the future. Have a wonderful weekend!

Sincerely
 
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Michldon responded:
Dear Doctor,

As the last visit to my ENT on 04/30/2009, he recommended me to re-start using NASONEX with 2 puffs in to each nostril every morning and take one AMOXICILLIN 500MG capsules by mouth three times daily.

After I took two weeks medicines with NASONEX and AMOXICILLIN 500MG, nasal discharge with blood-streak still kept happened every one/two days when I blew out from my left nostril. As the recent visit with my ENT on 05/12/2009, he recommended doing functional endoscopic sinuses surgery with Entrak CT scan for me.

It is really hard for me to decide whether I do need to go with this sinuses surgery because I have no idea totally. Since my ENT is on vacation now, I must make the decision about this surgery before he come back around the middle of June.

Here are my questions:

Q1: As you mentioned before, blood-tinged mucous is quite common because the nasal mucosa is very vascular and it doesn't take much of an incident, just inflammation, to cause it to bleed slightly. However my bloody nasal discharge kept happened from my left nostril more than 3 months, is it still common in sinusitis? Please give me your comments again since I still worry about it so much.

Q2: What's the major purpose of this functional endoscopic sinuses surgery? Is it going to resolve my sinusitis only, or resolve my sinusitis and bloody nasal discharge both?

Q3: From my previous sinus CT scan result, it indicates extensive chronic left maxillary sinusitis with obstruction of the osteomeatal complex. However recently I suffered the pain around left orbital cavity. As I heard, maxillary sinusitis wouldn't cause orbital cavity pain. Please share me your comments about it.

Q4: Since I did sinus CT scan on 02/09/2009, its name is 2.5mm direct coronal images through the paranasal sinuses with axial reformations. As the recommendation by my ENT this time, it requests me to do Entrak CT scan before doing functional endoscopic sinuses surgery. I don't know what's the difference between my last sinus CT scan and Entrak CT scan. Which one is more accuracy to exam my current symptom, Entrak CT scan or my last sinus CT scan to exam my current symptom?

Q5: If I don't decide to go with functional endoscopic sinuses surgery but I do like to one CT san to verify inside my nose/sinus, shall I go with this Entrak CT scan or sinus CT scan as I did in the last time?

Q6: Is there other option to treat my sinusitis since I am afraid to go with this surgery? As I heard, it may be much more difficult for the ENT doctor to treat you if you have already had surgery before and get sinusitis again. Is it true? Will this surgery resolve my sinusitis completely? Is there any risk by this kind of surgery?

Please give me your suggestion since it is very important for me to make the decision. Thanks so much for your time.

Best Regards
 
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Rod_Moser_PA_PhD responded:
I can help provide information, but only YOU can make those decisions. Have you considered getting a second ENT opinion -- from someone who can physically examine you AND review those CT findings (not just the report). As I mentioned before, CT findings MUST be correlated with direct examination findings.

1. I know you are concerned about the blood being a sign of something serious but since the CT scan and endoscopy did not reveal any serious manifestations, this is not likely. Without the ability to examine your nose, I really cannot specifically comment, but chronic sinusitis could be the underlying cause.

2. Only your ENT could answer that question. I am not sure what type of procedure he is going to do, or whether it will resolve your issues.

3. Both the maxillary and ethmoid sinuses can cause discomfort in the orbital area. You have both....

4. Again, not enough information. You would need to ask the end why he wanted this additional CT.

5. I can't answer that for you. Again, this is between you and your ENT.

6. There are always risks associated with any surgery, and not all sinus surgeries will be curative. There are no guarantees. As far as non-surgical treatments that may be available, I don't know the details of your case enough to know if you have alternatives. This is why I suggested you see a second ENT for an official "second opinion".

As much as I would like to help you, there are only so many comments that I can make without having access to records, test results, etc.
 
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Michldon responded:
Dear Doctor,

I really appraciate your time and patience to read my questions and give me so many suggestions.

I will take your suggestion to consider seeing a second ENT for an official "second opinion".

If I have any question in the future, I will come back to discuss with you.

Again thank you so much for your kindly help.

Best Regards
 
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Rod_Moser_PA_PhD responded:
You are very welcome....


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