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    Chronic Sinus Issues with Maxillary Retention Cyst - Need Input.......
    stevieswen posted:
    I have been dealing with chronic sinusitis issues for months. They have been getting worse and not better. After seeking consult with an ENT and having a round of Augmentin (antibiotic) and two CT scans with mucosal thickening, etc., I was diagnosed with a 2.9cm retention cyst in the left maxillary sinus. Flash forward and two weeks ago, I got bronchitis. I was sent by my ENT to a pulmonary specialist who diagnosed the bronchitis. I was given a Z-Pack and had an allergic reaction (bad hives all over). I ended up in the ER for the allergic reaction. In the ER, They did a CBC, Chem 12 and chest x-rayall came back normal, which I was told I had a viral infection. I have coughed so hard that I have upset my back (have a history of cervical and lumbar stenosis, disc bulges, etc.) and neck and now my hands and feet have numbness and tingling which I need to see my spine Dr. for. In the meantime, my visit today with the pulmonary Dr. showed that my lungs sounded clear, however, at night, when I lay down, I wheeze and there is a crackle sound, like pop-rocks in my throat. The Dr. states that is due to the post nasal drip that happens at night and pools in my throat. The glands in my neck are swollen still. I am on prednisone for the hives...they are that bad. I'm having a hard time sleeping, I'm very congested and can barely breath out of my nose, either side. I've been off work for a week. My ENT wants to schedule sinus surgery to remove the cyst and take care of a deviated septum. It's felt that all my sinus issues are now contributing to the bronchitis issue of late. I will be going for a second opinion very soon.....something I thought would be a good idea before deciding on surgery. I'm exhausted from not getting good sleep. I believe I need surgery, but need to know if it will truly help. The constant congestion and tightness in my face is not acceptable and making me miserable. I need input as to my diagnosis and if surgery is the way to go or if there is something else I should be considering, etc. I tend to have cysts everywhere....scalp, hands, thighs, ovaries, uterine fibroids, abdomen.....its a familial trait on my dads side. My dad and his dad are the same way. All cysts have benign. For my sinuses, are my symptoms typical for what I have? Also, is it common for the sinus infections to last so long and then create other upper resp. issues? Any guidance you can give is much appreciated.
    stevieswen responded:
    I should also add that I have been dealing with the bronchitis for a little over two weeks. Was given a Z-Pack and Levoquin for which both I had an allergic reaction. I have been running a 99-100 fever off and on for three days. How long should I expect a fever to last. If my lungs are clear and X-ray are clear, then do I still have bronchitis? My cough has gotten much better, but still don't feel like bronchitis is fully gone. I have it many times before. Just don't know what to do to get well......
    Rod Moser, PA, PhD responded:
    Not all cysts are created equal. For instance, a cyst in the ovary or uterus is not related in any way to a mucoid cyst in the sinuses. They caused by different things. A cyst is just a hollow growth filled with fluid. There are sebaceous cysts in the skin, cystic acne, mucoid cysts in the mouth, ganglion cysts, etc.....all different, and not really familial.

    I don't know if you need to have surgery or not. I would need to examine you and review your diagnostic studies, so I am pleased that you are going to have another ENT examine you for an official "second opinion". Many retention cysts and deviated septums are left alone, but because you have chronic sinusitis, your case may be more involved. You may have some structural problems that may be improved by surgical intervention.

    Chronic sinusitis can cause bronchitis, but it doesn't mean that they are all bacterial. Most cases of sinusitis and bronchitis are viral and will not respond to antibiotics.

    Prednisone is very stimulating and will interfer with your sleep, so make sure to take it in the morning.
    stevieswen replied to Rod Moser, PA, PhD's response:
    Thank you so much for your feedback, that is very helpful. It's good to know about the cysts....I tend to have lots of them and Dr.'s tend to be a little perplexed as to why I have so many.
    It's also good to know that the chronic sinusitis can cause the bronchitis. The question is, how do I stop the cycle of being sick. I'm not sure how best to address the sinus issues but am glad to be getting a second opinion. We'll see what is said on Tuesday which is when I have my appointment.
    I do have a question for you regarding the hives I got from the Z-Pack. This morning, I woke up with a swollen upper lip. I took Benedryl (for the itching of the hives) and it went down. Is this something that could be related to the hives or the sinus infection getting worse? Also, I have numbness and tingling in my mouth and tounge, hands and feet. Wasn't sure if that was from meds, coughing so violently or something else. Lastly, how long does it take for Bronchitis to run its course? My glands are still swollen, but today, I don't have a fever, but my energy is still not 100%........just wondering......
    stevieswen replied to stevieswen's response:
    I should also add I have lost my sense of taste and smell. I assume that's due to the sinusitis. I have been taking the prednisone in the a.m. and the Benedryl throughout the day for the hives.
    On any usual day, I can not breath through my nose and it's been that way for over 4 months now. As for my history, I have a history of several sinus infections a year and was always given some sort of antibiotic for them. When I was very young, I had ear infections, post nasal drip and tonsillitis quite a bit.
    In my adulthood, the sinus issues have been getting worse. The two CT scans I had have shown that the infection is worsening and not resolving. Is there anything I can do besides surgery to help this get better? How can I boost my immune system and help support my body, etc?
    Rod Moser, PA, PhD replied to stevieswen's response:
    I don't think that "boosting your immune system" at this point will change the structural problems that you may have in your sinuses. Again, without the ability to examine you, review your scans, etc., I would not be able to determine if there area any non-surgical would need to physically see an ENT for a second opinion. Bring copies of those test results, or the actual scans with you to your second opinion visit.
    stevieswen replied to Rod Moser, PA, PhD's response:
    Update as of 6/1/12......
    I went for a second opinion regarding the need for sinus surgery. The Dr. I saw did not agree with the first ENT and did not think surgery was necessary at this time. She looked up my nose with the camera (which the first Dr never did) and saw that my turbinites were inflamed, saw lots of mucous, the deviated septum and said all the inflammation was probably allergy related. She wanted me to try another nasal spray and said that should help greatly. She also told me how to prep my nose with a saline wash which will help lessen the irritation. Based on my CT scans which state the following:
    "paranasal sinus disease, large retention cyst within the inferior left maxillary sinus and very small air fluid levels within the maxillary sinus and bilateral sphenoid sinuses, which may represent acute sinusitis if in the clinical presentation"
    The 2nd opinion ENT stated that she didn't think I had sinusitis but that what I was experiencing was allergy driven. I saw an allergist yesterday and he looked at my CT and said I had a sinus infection. My question is this.....based on the CT scan, do I have a sinus infection or not? My history has been constant post nasal drip all my life, and over the last many months have been having a lot of congestion in my ears and head. The 2nd opinion ENT seemed to think that if we treat the inflammation, get that reduced, we can better evaluate where we're you agree with this approach? Any insight you can give is much appreciated. I know it's difficult as you can't examine me, but hopefully quoting my CT scan is helpful for you......
    Rod Moser, PA, PhD replied to stevieswen's response:
    Sinusitis produces fluid, and that fluid is mucous/snot. A CT can can spot the pooling of this mucous at the moment the scan is taken. This fluid, however, can wax and wane over time, so the CT only sees what it sees at that moment. Your CT scan showed a small fluid/air level (air is supposed to fill the sinuses). As a matter of fact, the scan qualified this amount by stating you had a "very, small" amount that must be clinically correlated (your medical provider has to make the call based on examination findings). Although I can see the scan or examine you, the CT does not conclusively prove that you have sinusitis. A CT scan of someone with severe or chronic sinusitis is quite obvious....there is a LARGE air/fluid level in those cases.

    Most cases of sinusitis are viral anyway. Some are allergic. Some are both. A few may be bacterial. In your case, allergies may be playing a major role. Viruses resolve on their own; allergies take time to properly manage.

    Assuming that you are not going for the first recommendation of surgery, I see nothing wrong with aggressively trying to manage your case based on the assumption that allergies are your underlying culprit. Even if you had surgery, it would not change the fact that you ALSO may have allergies.
    stevieswen replied to Rod Moser, PA, PhD's response:
    Thank you so much for your is greatly valued. You are correct. I am sticking with the 2nd ENT who I feel has been more thorough than the first Dr. Thank you for clarifying have made things make more sense for me. Understanding all this and being an informed patient is important to me and you have helped me greatly.
    One last question....I am supposed to fly to Maui in do I best prepare my sinuses so I don't have any trouble on the flight? I'm a little nervous about that since in April, I took an hour flight and lost my hearing temporarily due to the fluid and altitude......
    Rod Moser, PA, PhD replied to stevieswen's response:
    Your sinuses will likely be fine flying to Maui. Changes in altitude, usually a rapid landing, can cause some issues even with normal ears, so you can do a few things to decrease your chance of barotitis (barometric-related ear pain). The approach to the Maui airport tends to be more gradual....a long and gradual descent, as opposed to some airports where you think you are nose diving into the group. Gradual and slow descents allow your ears time to equalize pressure.

    Learn to do a gentle, val salva decompression manuever by pinching your nose and blowing, or pretend to try and blow up your thumb like a balloon. You will look a bit silly, but this will help open your Eustachian tubes. Chewing gum and swallowing will help, too. There are small earplugs called EarPlanes that are supposed to help, but I get mixed reviews of them. Drink plenty of water on the plane which tends to be dry.

    Before your flight, you can take a decongestant or use a short-acting nasal decongestant spray like neosynephrine. This can help on the prevention end.

    No method is 100%, but these should help.

    If you plan on snorkling, this will be another issue if you dive deeper, so if your ears or sinuses hurt, don't dive....just float on the top and look down.

    Have a great vacation.
    stevieswen replied to Rod Moser, PA, PhD's response:
    Thank you so much for your shared information. It's very helpful and it's good to know that I can take that flight to Maui! I am pleased to report that the nasal spray the 2nd opinion ENT prescribed me along with using the saline wash has already helped and I am breathing out of both nostrils for the first time in many many months. Though sometimes one still gets blocked, overall, there is already an improvement. I did see an allergist who is investigating via blood test for now (I had a sever allergic reaction to a Zpack and I'm recovering from some pretty bad hives and can't be skin tested right now, so we're doing blood tests for allergies) what may be driving suspected allergies. I also saw another specialist who also strongly suspected that what's been driving all the inflammation in my sinuses is allergy related. So I think we're on the right track. I can't thank you enough for all your help and has been very reassuring.
    Rod Moser, PA, PhD replied to stevieswen's response:
    You are very welcome. Aloha.
    stevieswen replied to Rod Moser, PA, PhD's response:
    Quick update....saw the allergist. Due to the sever allergic reaction I'm currently having to a z-pack I was given, the allergist did allergy testing by blood instead of skin test. Everything came back negative. He stated that the blood test is less accurate then the skin test and its possible that I show up positive in the skin test once we can do that. Would agree with this? If I end up showing negative for allergies, then what should be my next step ENT wise? If allergies aren't driving the sinus issues, what else could be? Should I repeat the CT but by another facility to get a different person's interoperation? I have to wait for my hives to go away before I can get skin tested allergy wise, but I am just wondering what my plan B should be just in case........thoughts?
    Rod Moser, PA, PhD replied to stevieswen's response:
    Yes, skin testing for allergies is more accurate....but blood or skin tests only check for specific, common allergens (there are thousands), so you could be allergic to many things that you were not tested for. Many times, finding the specific allergen is not necessary since many environmental allergens are unavoidable. You can still be treated like you have allergies without knowing the culprits.

    I do not know if you need another CT scan now or not....I don't have enough specific information about you case to really determine the "next step" or Plan B....I am sorry. In order to make those patient-specific decisions, you would need to actually be my patient....
    Presh_S responded:
    I have suffered chronic sinusitus for the last 6 months till finally my family doctor sent me to EMT who found a very obvious cyst in my left sinus cavity. It had gotten so bad and huge that my left side of face was numb, my left eye vision was blurry and I developed a rash across sinuses from inflammation. As I type this I am recovering from my cyst removal surgery I just had this morning. I never felt such relief. Breathing is much easier and the rash is already gone. There has been no pain at all. I feel groggy and tired bu that's it. To be honest the first words I said when I woke up from anasthesia was "I can breathe"

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