Q & A

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

I have dizziness and eye pressure. Do I have vertigo?

Question: I am a previous patient of Dr. Krevitt (saw him back in September 2011) and would like to know if I should come in and see you guys. I started having the following symptoms about two weeks ago: dizziness, unsteady feeling, eye pressure, headaches, neck pain, and high blood pressure. I went to my primary care physician who had me do follow up EKG and echocardiogram – both of which were completely normal. I am supposed to go in for an MRI on Monday, but I’m not sure what exactly the doctor is looking for. At this point, all symptoms have subsided with the exception of the dizziness and eye pressure, and it goes away when I am sitting down. Seems to be pronounced when I am looking up, or in bright lights. Would it be best to come into your office prior to the MRI? I’ve never had vertigo, but wonder if that is what I’m experiencing? Do I have vertigo?

Answer:

There are many possible causes of your symptoms, including problems with the inner ear. It sounds like your primary care physician has been doing the right thing- but it certainly would make sense to have a thorough ENT examination. Dr. Krevitt would be a great place to start, but you might consider seeing Dr. Neil Sperling, one of our partners. Neil is a Neuro-otologist, who sub-specializes in dizziness and the inner ear. He would likely suggest an MRI of the inner ear at this time. If that is what you are scheduled for, it is probably OK to see him before or after the films. If after, see if you can bring a copy of the films or disc with you.

I hope this helps clear things up.

Robert Pincus MD, FACS
NY Otolaryngology Group- NY Voice Center
Associate Professor Otolaryngology NYMedical College

Q & A

Peppermint tea causes me to have a sinus headache after sinus surgery

Question: I had several procedures done with sinus surgery (turbinoplasty, FESS) 4 weeks ago. I followed a doctor’s instructions as far as diet, and activity during the recovery period. It all went very well, minimal pain, until this week when I started drinking peppermint tea daily. I didn’t make any connection between the two, but my sinuses start hurting right after the tea. As a matter of fact, one day I had two cups of the tea and the pain was really bad. Can you get a sinus headache from peppermint tea? I thought peppermint was good to treat sinus problems. Thank you.

Answer: This really is rather interesting. We have found and reported in the medical literature that acid reflux (either known or “silent”) is a frequent cause of chronic sinusitis. In our study, eight of eleven patients with sinusitis who failed regular medical care, had significant reflux of stomach acid as high as the sinuses. Patients were studied over a 24 hour period with pH (acid monitors) in the back of the nose. In these patients, reflux was the likely cause of their recurrent infections. Most had no or few other symptoms of reflux and found that their sinus problems improved or resolved when their reflux was treated (diet -with or without medications). Surgery can often be avoided with such treatment.

One of the more common agents worsening reflux is peppermint. So yes, you can get a sinus headache from peppermint tea. Please see the page below for some more information

http://www.nysinuscenter.com/treatment/

While there may be some other, unexplained etiology, acid reflux is by far the most likely cause of these symptoms- and may have been part of the cause of your sinus problems that necessitated surgery.

I would ask your surgeon to evaluate whether you do in fact have reflux which may be worsening your symptoms. If so, treatment will likely lead to a better long-term outcome from your surgery.

Clinical evaluation may be enough, but at times we do 24 hour pH testing in the nasopharynx. This accurately measures whether acid is in fact coming up to your sinuses, when it happens and what exacerbates the problem.

We would be happy to evaluate you here at the sinus center if you are in the NY area.

I hope this clears things up.

Robert Pincus MD

Co-Director NY Sinus Center

Associate Professor Otolaryngology

Q & A

I have persistent headaches and dizziness. Will I have to suffer with this the rest of my life?

Question: I have had numerous sinus surgeries – I have even had the sinus cavity in my forehead removed and filled in with artificial bone material. I have have been cut so many times in my eyebrow area and as a result, I now have persistent post-sinus surgery headaches. I continue to have severe headaches every day. I have been told that my headaches come from the damage to the nerve endings in my head due to so many sinus surgeries. About four years ago I developed Vestibular Neuritis – my right ear now controls the balance for my body – but this has made my headaches worse and if I get very tired or stressed my balance issue becomes worse. My life has totally been affected by all of this – I go to work and back home – I cannot stand to be in a crowd or hear loud noise – I have been to several ENT, and ear specialists and even the head of the ENT at Southwestern Medical in Dallas and they all say the same thing – I will have to suffer from this the rest of my life.

Answer:

Thank you for your question. You really have at least two problems that affect each other. While both are troublesome and difficult, neither is impossible to manage.

Headaches can often be from sinus problems- but other issues can cause headaches as well. However, about 10% of people who have had bone flaps for their frontal sinuses wind up having persistent nerve pain in the area. With today’s minimally invasive procedures- such as image-guided endoscopic surgery and balloon sinuplasty- that procedure is rarely done, except for a persistent bone infection (0steomyelitis) of the skull. If the infection has resolved, the pain may be treated with medications for nerve pain and sometimes with an anesthetic injection and steroids into the area of the nerve. Sometimes the root of the nerve causing the pain can be cut- although this may require a procedure from neuro (brain) surgeon.

One can have damage to the balance nerve from many sources- the most common cause, we believe, it may be from a viral infection that damages the nerve. Sometimes, the damage is permanent- however, in general, the brain and the inner ear learn to readjust. I am not sure how long this has been a problem, but if persisting, we recommend balance (vestibular) therapy, which helps in most people. Frequently, when ill or under other stress, this learned readjustment can stop working well. That would cause the symptoms to temporarily, to recur.

It is imperative, of course, that other causes of imbalance have been checked for, and ruled out.

I hope this helps clear things up a bit.

Robert Pincus MD

Co-director NY Sinus Center

Q & A

I can’t breathe from my nose after jaw surgery

Question: I can’t breathe after jaw surgery. I had upper and lower orthognathic surgery two years ago which involved cutting into my sinus area. My surgeon found polyps and removed them. Ever since my jaw surgery my sinuses (near the bridge of my nose) have been congested. I can’t breathe out of my nose very well and my left ear feels blocked and pops often. This sinus pressure leads to headaches about 5 times a week. I have been prescribed various antibiotics, nasal sprays, and sinus irrigation – nothing seems to help. I have had a CT scan and an MRI and nothing seems to look abnormal to my surgeon and two ENT doctors that I went to see. My surgeon said all he saw was that my ethmoidal sinuses seemed like debris from the surgery had settled in them, but the ENT said he didn’t agree.

Answer:

I wish I could easily answer your question. There are many different possible causes for why you can’t breathe after jaw surgery. As you know, upper orthognathic surgery may cut through the maxillary (cheek) sinuses or even through the ethmoid sinuses (near the eyes- Leforte III type osteotomies). Orthognathic surgery is done on the bones of the upper and lower jaws, usually by an oral surgeon, to better align the bite and/or to improve ones facial appearance where the lower and upper jaws are too small or too big. While not usual, sinus problems can ensue from this with the best of surgeons. I would think, however, that such a post-surgical sinus obstruction or drainage issue should be found on your sinus films.

One thing that may be more easily overlooked is the development of a nasal valve stenosis or narrowing- The nasal valve is just above the nostrils, where your nose opens and can lose support from surgery or other cause.
This can be diagnosed by pulling out on your cheek, just where it joins the nose inferiorly- and seeing whether that improves your symptoms. The subtle anatomy there can be changed from surgery or other causes and give you nasal obstruction- and be overlooked. Breathe-rite strips may temporarily improve one’s symptoms in this case.

Of course, there are other possibilities that may be unrelated to the surgery- including recurrence of polyps or new sinus problems –

We would be happy to see you here in the sinus center. If you can come in, please bring your most recent sinus CT scans, and earlier ones as well if available.

Robert Pincus MD

Co-Director NY Sinus Center

Q & A

Revision Sinus Surgery – Is It Necessary?

Choosing to have sinus surgery can be a difficult decision. Despite all of the advances in medical technology, there will still be some pain and swelling. Plus, getting surgery is just plain scary…we understand that. What can be even more disheartening, however, is having sinus surgery and still suffering repeated bouts of sinusitis. The good news is, in most cases, revision surgery isn’t necessary.

As mentioned in a previous blog post (link), the post-surgery recurrent congestion or pain could be due to:

Allergies
Nasal polyps
Acid reflux
Headaches
Immuno-deficiencies

Treating these underlying conditions may clear the congestion and the pain, without the need for revision sinus surgery.

In some cases, however, an additional revision sinus surgery may be necessary. The goal of sinus surgery is generally to enlarge the natural ostium, or opening, of the sinus. If a surgeon misses the natural opening by so much as a millimeter, he or she will make an opening in the wrong place in the sinus. In these cases, the patient may have problems with the mucus recirculating—going out of one opening, and coming right back in the other opening.

In these situations, additional surgery may be required. Fortunately, this revision surgery should be much simpler than the original surgery, as it entails solely shaving down the tiny bridge of tissue that separates the openings. This is typically extremely straightforward, and can sometimes be done as an office procedure.

Revision surgery is one of our specialties. If you have any questions about it, please contact us today. You can breathe easier, and we can help.

Q & A

Severe Pressure and Pain in Eyes and Head

Question: My 25-year-old son in law has had severe pressure and pain in his eyes and head. He is finishing med school as has been to various doctors trying to alleviate his problem and they have ruled out Vacuum Sinusitis as well as other obstructions. He does have a polyp, but according to the doctors, nothing that would cause this pain. He is devastated with the pain for over 2 months. What do you suggest?

Answer: Headaches can be due to many different causes. While sinus problems can frequently cause headaches, unless caused by an acute (new severe) infection, sinus headaches tend to be dull and persistent. They are usually located over the area of the sinuses involved, except for headaches from the sphenoid sinus, which tends to cause a headache at the top or back of the head. There is some thought that contact points- that is when the septum touches the side wall of the nose, can cause severe headaches- but not all agree with this philosophy.

We would be happy to see your son in law at the NY Sinus Center, to help find a cause and treatment of his headaches. Imaging by CT scan should be done if he has not had this already and he should have a thorough neurologic examination as well. We work closely with headache specialists and others who can help, should the pain not be from his sinuses.

Robert L. Pincus MD

NY Sinus Center

headache Archives - The New York Otolaryngology Group

I have dizziness and eye pressure. Do I have vertigo?

Peppermint tea causes me to have a sinus headache after sinus surgery

I have persistent headaches and dizziness. Will I have to suffer with this the rest of my life?

I can’t breathe from my nose after jaw surgery

Revision Sinus Surgery – Is It Necessary?

Severe Pressure and Pain in Eyes and Head