Frontal Sinus Obliteration

Question:
Colenso Thanks for this link; I recall reading it some time ago and wishing I hadn’t! To be fair, my ENT has always warned me of serious complications, if I went untreated: To avoid continuous anxiety,  I choose to forget this most of the time! I’ve been violently allergic to various inhaled allergens for years; my IgE levels are off the scale for mite and pollens.
I recently had a ‘new’ (to me) test for exhaled nitrous oxide, which measures inflammation in the respiratory tract; this too was off-scale. My allergist thinks the polyps are caused by allegies; my ENT thinks they’re caused by infection; neither can get rid of them! Because my frontal recess is almost always blocked by polyps (at least the last four months it has been) they can’t visualise the frontal ostium to see if it’s still scarred up. My sinus infections have been cultured repeatedly over the years; always staph and/or hemophilus influenzae. I’ve never shown any fungal infection, even most recent tests. The antibiotics never seem to get rid of the infection completely; it comes and goes (it seems) with a life of it’s own. Except I’m usually OK in the summer when my pollen allergies are at their worst. Every clinic visit, when I’m ’scoped, both my ENT and allergist look more depressed. I’ve built up a close (hah!) relationship with them over the last three years, but I’m clearly one of their ‘failures’. I just see years of treatment and clinic visits stretching endlessly ahead. I already attend one of the best university hospitals for this in the country, and have had every relevant test and investigation, some only at research stage. As I said in my last post, I think I’m at the end of the line. Except of course I’m not, as my allergy-related problems will continue, and I may yet develop similar problems in my left sinuses! SFL

Response:
I haven’t had a consult with an infection-control doc direct, but I believe my ENT has done so, about three months ago when a supposedly ‘curative’ IV course failed to work. I have seen an immunologist, who scared me by discussing all of the obscure syndromes which could be causing my abnormal blood results.  As I’m otherwise in perfect health, I found him not-too-convincing. I guess I’m quite lucky, in a way, because, although I’m low-grade sick for six months of the year from the sinusitis, I find I can work OK. In fact, it takes my mind off the continuous frontal headaches. The worst thing is my voice gets very nasal, so I sound like I’ve got a heavy cold. Plus, I’m convinced I have severe halitosis! In the summer when my pollen allergy is bad, I _do _ miss work for days when the counts are high. However, my allergic asthma, which was very bad around five years ago, is now much better controlled. I don’t know about you, but I find it hard to complain,even when I feel bad. ‘Sinusitis’ sounds so trivial, unless you’ve had it the way the people on this ng have.  A lot of people think it’s how they feel after a cold for a few days. I look quite normal; only my ENT sees the disaster which is the inside of my nose! Also, as with any chronic complaint, even sympathetic co-workers get tired of you being unwell. I hope not to have to be away from work for too long if I do go for this frontal obliteration, but my ENT wouldn’t be drawn on that, either! SFL

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Response:
>All sinus >problems can be figured out it’s just a matter of ruling everything >out and what remains is the truth.
It sounds so simple, doesn’t it? Find out what’s wrong, then fix it! My ENT thinks (and I guess he’s probably right) that my problems are caused by a glitch in the way my skull developed, combined with my extreme allergic status. I can buy that because my problems have been one-sided, primarily (I do get sinusitis on the other side, but it always clears easily with antibiotics).  Also, one of my ears is around half an inch further back than the other, and I’m very near-sighted in one eye only! This supposed ‘glitch’ doesn’t show up on the CTs I’ve had, and the ENT wanted me to have another, pre-op. I’ve refused, as I’m concerned about radiation dose to my corneas (if the sinusitis doesn’t get you, the ionizing radiation will…). He caved in on this one, as I’ve had good MRIs for him to work from… If I go ahead. How about you? Are your problems structural, or infection, or what? Do you have a long history? Have you had surgery? SFL

Response:
Dear DP This is a bit off-putting! I think I am close to the end of the road, tho’. My four previous FESS procedures cleared progressively further up my nose, and the last one ( a year ago) drilled out the frontal sinus floor (after an earlier, unsuccessful attempt at stenting). But it has scarred up again, and my frontal recess is full of polyps which recur as soon as I stop taking steroids (I’ve been on continuous antibiotics, IV and oral, for close on six months). More questions; Did they shave your head? was there bruising? Did you get drains in? How soon did you feel like going back to work? I asked my surgeon all of this stuff, but he was evasive (I thought). I think he feels I really need to get this procedure done, and didn’t want to put me off. I would get a second opinion, but I have already gone through tertiary referral, and this guy is the best there is, and I respect his opinion. He was able to show me on my last MRI where the chronic infection is ‘thinning’ the bone above my eye socket. (All of my problems are on just one side). He’s also cagey about guaranteeing success, but said he felt it was my best chance for getting rid of my chronic infection, and that if I developed further complications, I might end up needing it as an emergency procedure anyway. So…I have a choice, I guess, but it almost feels like no choice. I keep telling myself that sinusitis isn’t like – fatal – but it’s really getting me down now. It helps to know I’m not alone! Many thanks for your good wishes, anyway. SFL

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Response:
>Has anyone had this >done? If so, what was it like? Painful? Long recovery? Ultimately effective >in >resolving frontal pain?
Yes had it done in 96. The pain was like going threw 12 rounds of boxing and losing the fight it was not fun.Recovery time seemed longer mainly because they cut me from ear to ear on top of my head and that had to heal. The frontal pain is still there if not worse having the titanium mesh and screws in my forhead from that surgery doesn’t help matters much. I was infected all the time with alot of painfull headaches I felt it was worth it if the surgery would help the headaches but it didn’t. Don’t be shy about asking your surgon alot of question about the surgery. Good luck DP

Response:
After years of chronic sinusitis, four sets of FESS, and trials of endless combinations of antibiotics/steroids/irrigation etc etc, my ENT has finally suggested I have the ‘big’ operation, frontal sinus obliteration. He has given me the choice of whether to proceed with this major operation, however. I have been very bad for the whole of this last winter, even on continuous antibiotics and high-dose steroid nose drops, and have to weigh up whether I can go on the way I have been, or else go for what sounds an extremely unpleasant procedure (much worse than FESS, which I have always found a breeze). Has anyone had this done? If so, what was it like? Painful? Long recovery? Ultimately effective in resolving frontal pain? I recall there were some posts about frontal obliteration on this ng a few years back, but now Deja has gone to Google, the archive seems to have been lost for search. Thanks for any responses. SFL

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