Hello doctor, I have had a CT scan done of my sinuses. I would like a second opinion as to the severity of the findings and the best next step if you think that is needed.
Hello. I understand that you are a 66-year-old woman with runny nose problem and headaches, worsened over last few years, been there ever since you moved to new place. Your CT scan suggests there is some inflammatory changes in the sinuses (the exact sinuses as described in the report) (attachment removed to protect patient identity). Based on your CT report, I cannot conclusively give you any suggestion as to what has to be done for solving your problem. But what I can tell you is how things can be alleviated, what plan of management can be thought upon, what other things you need to tell us, what else to observe for you to be watchful. I would like to know if you suffer from any of the following, if so then the duration, any worsening recently. Nose block, reduced sense of smell, post-nasal drip, foul smell in mouth (bad breath), facial pressure or brow pain, cough, asthma, wheezing, breathing difficulty.  Next, did your scan centre give you the relevant cuts of the CT scan? The film I mean. If you can upload the CT films it will be great. Reason: the report of the radiologist is based on his radiological practice which is far from the clinical practise. Whether these findings are significant or warrant an aggressive action will depend on an ENT specialists assessment of the films. For the same, I request you to send me the CT films if that is possible. If you were to come to me, I would do a nasal endoscopy in office after local decongestant and anesthetic spray to look for any frank congestion, mucus, pus, enlarged turbinates, anatomical abnormalities, mucosal abnormalities, deviated nasal septum, allergic signs, etc. At the very outset, I would keep the Cetrizine (Zyrtec) intact with an additional Montelukast (Singulair) component. I would put you on Flonase (Mometasone or Fluticasone) nasal spray. The spray has to be taken in a particular way, mind it. Can help you with regards to that if you need help. Whether to go for a conservative management (medicines, sprays, steroids) or a surgical one (endoscopic sinonasal surgery) would depend on the endoscopy and CT correlated with your detailed history. At least I would be able to point to a proper plan of action then. If there are polyps, we would like to bring them down with a course of steroids (oral, provided you are not diabetic or hypertensive, are you?) and then reassess with sprays and eventually may need surgery. If there is deviated nasal septum, that would also need a surgery (can be done with sinus surgery together). If there is any anatomical blockage of sinuses which will not be addressed by medicines, then again surgery.  For long term management of the issues, we need to rule out allergy. A skin prick test is useful for that. You would need Zyrtec, anti-allergics and nasal sprays even after surgery to prevent recurrence. However, your quality of life would be much better with a surgery if that is indicated. Symptoms to watch out for are severe pain, proptosis of eyes, loss of vision, bleeding from nose, severe sudden nose block, etc. Do revert back to us with more details and shall guide you on what has to be done. As such with the limited information available with the CT report, I would not go for surgery now.