Hi doctor, For the past eight months, I have been struggling with brain fog, tension headache, fatigue, and inability to concentrate. I have been trying to identify the source of my problems with no luck. An MRI of the brain coincidently showed fluid retention in the left maxillary sinus, so I have done a CT scan of the sinuses to confirm the findings. I need to mention that I smoke water pipe (shisha) and after smoking, I find mold growth in the humid parts of the shisha, so I thought this must be fungal sinusitis. In addition to the previous symptoms, I sometimes feel pressure behind my right eye, and I always feel sputum in the back of my throat. My doctor thinks that the sinus in the CT scan is minor and would not have contributed to my issues. Please suggest an opinion. I am currently taking Lexapro 10 mg.
Hello.  As per your CT scan (attachment removed to protect patient identity), there is some mucosal thickening in the left maxillary sinus and some inflammation in both posterior ethmoid sinuses. The nasal passage are very much compromised. The turbinates are hypertrophied. This may be due to sinusitis as well as your smoking shisha. The findings explain the dullness you might be feeling behind the eyes and on cheeks, the occasional headache, and pressure behind the eye. This, however, does not explain the brain fog, tension, and fatigue. You will be benefited from some sinus medications. You should quit shisha. You will need to use steroid nasal spray for many weeks. You will need an antihistaminic also. However, since the nasal passages are obstructed the medicines may not reach the destined areas. If we encounter that problem we will have to think of surgery. But for now, you start on a steroid nasal spray and antihistaminic.