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Dr. Phil, MD
Dr. Phil, MD, Medical Doctor
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I have had sinus problems for a time. I had a scan done once

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Hi,
I have had sinus problems for a long time. I had a scan done once in 2009 and the again last year and the ENT said there was nothing there (results below). About 8 weeks ago I got a horrible cold with more drainage than I had ever had before. Ever since I have had horrible pressure behind the bridge of my nose and forehead/eyes. I started blowing yellow drainage and my doctor put me on an antibiotic (augmentin). After 7 days I no longer had yellow drainage but the pressure was still horrible. My doctor put me on a 5 day course of prednisone (20 mg) day (yesterday). So here are my questions.
Is the scan normal as the ENT suggests? How long before the prednisone should help with the pressure? Any other feedback you can offer?
CT SINUS COMPLETE WO CONTRAST Final result Tue Mar 26, 2013 1053 EDT
Report Narrative
CT PARANASAL SINUSES
Clinical Indication: Chronic migraines. Persistent maxillary sinus
pain bilaterally. Evaluate for radiographic sinusitis
Prior exam: 01/20/2009
Technique: Axial plane without contrast. Sagittal and coronal
reformats were obtained. Soft tissue and bone windows.
Findings: Right maxillary sinus is clear. Right maxillary sinus
ostium and right ethmoid infundibulum are patent. The right hiatus
semilunaris and right middle meatus are well-aerated.
Tiny nodular opacity in the superomedial left maxillary sinus
bordering the medial aspect of the left ostiomeatal channel however
there is patency of the left maxillary sinus ostium and left ethmoid
infundibulum. The left hiatus semilunaris and left middle meatus are
aerated.
Frontal sinuses are hypoplastic, left greater than right. Frontal
recesses are patent.
Opacification of a solitary right anterior ethmoid air cell adjacent
to a tiny osteoma. Ethmoid air cells are otherwise clear.
Mild opacity along the anterior margin of the right sphenoid sinus
which appears to obstruct the right sphenoid sinus ostium. Left
sphenoid sinus is clear and the left sphenoid sinus ostium and left
sphenoethmoidal recess are well-aerated.
Mild sigmoid curve to the nasal septum. Both sides of the nasal
cavity are well-aerated including the middle meatus regions.
Paradoxical scrolling of the anterior middle nasal turbinates.
Keros type II olfactory fossa.
Mastoid air cells and tympanic cavities well-aerated bilaterally.
Soft tissues of the nasopharynx and visualized oropharynx are
unremarkable. Limited intracranial views are unremarkable. Orbits are
unremarkable.
Impression:
1. Small nodular opacity adjacent to the left maxillary sinus ostium
and left ethmoid infundibulum which are patent.
2. Opacification of a solitary right anterior ethmoid air cell
adjacent to a very tiny right osteoma.
3. Mild opacity along the anterior margin of the smaller right
sphenoid sinus which appears to obstruct the right sphenoid sinus
ostium.
4. Mild sigmoid curve to the nasal septum with good aeration in both
sides of the nasal cavity.
5. Comparison with the previous examination dated 01/20/2009 reveals
that the solitary opacified right ethmoid air cell and tiny adjacent
osteoma were not present previously. Also not present on the prior
examination is the mucosal thickening in the anterior right sphenoid
sinus impinging upon the right sphenoid sinus ostium identified on
the present study.
Dr. Phil, MD :

Hello. I'm Dr. Phil, licensed and practicing Internal Medicine Physician. Excellent service is my goal.

Dr. Phil, MD :

please enter chat mdoe

Dr. Phil, MD :

mode

Dr. Phil, MD :

standing by

Dr. Phil, MD :

Hi. I'm Dr. PHil.

Dr. Phil, MD :

Can I ask your first name?

Customer:

Steve

Dr. Phil, MD :

Hi Steve. Nice to meet you

Customer:

Thanks. . I assume you have my question>?

Dr. Phil, MD :

Yes, I do.

Dr. Phil, MD :

:)

Dr. Phil, MD :

Your CT is not normal.

Customer:

Great.

Dr. Phil, MD :

Have you ever had a scope into the nose?

Dr. Phil, MD :

and sinuses

Customer:

No

Dr. Phil, MD :

That is needed Steve.

Dr. Phil, MD :

I see evidence on that scan of possible obstruction like a polyp

Customer:

Wouldn't the scan show that?

Dr. Phil, MD :

All it shows is blockages

Dr. Phil, MD :

It

Dr. Phil, MD :

is not detailed enough

Customer:

If it is a polyp would the prendisone help?

Dr. Phil, MD :

No

Dr. Phil, MD :

It will decrease inflammation overall but it won't fix the underlying problem

Customer:

Would it help in the meantime? Until I get a scope?

Dr. Phil, MD :

yes

Dr. Phil, MD :

absolutely

Dr. Phil, MD :

It should work immediately

Customer:

Not yet. I just started taking it last night. Should I mention this to my provider or wait?

Dr. Phil, MD :

I would mention it.

Dr. Phil, MD :

Suggest a scope to look for polyps

Customer:

5. Comparison with the previous examination dated 01/20/2009 reveals that the solitary opacified right ethmoid air cell and tiny adjacent osteoma were not present previously. Also not present on the prior examination is the mucosal thickening in the anterior right sphenoid sinus impinging upon the right sphenoid sinus ostium identified on the present study.

Customer:

What does this mean?

Dr. Phil, MD :

It simply means that two different sinuses are blocked

Customer:

Then how is that normal?

Dr. Phil, MD :

It's not!

Customer:

Oh. . .I misread that. Sorry.

Customer:

Should I suggest sending this scan to a different ENT?

Dr. Phil, MD :

yes.

Customer:

OK I think I have all the questions answered.

Dr. Phil, MD :

Any more questions Steve?

Customer:

One last one. Should the ENT have done the scope after seeing the scan?

Dr. Phil, MD :

Yes, I would think so. It was definitely different from 2009 and you are having new symptoms. A scope is indicate

Dr. Phil, MD :

indicated

Customer:

An you said this scan indicates blockage. . ?

Dr. Phil, MD :

yes, that correct

Customer:

Thanks. . . .

Dr. Phil, MD :

You're welcome :)

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