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.

Salty Post Nasal Drip with Headaches After Surgery

Question
For nearly 3 years I have been getting salty post nasal drip with headaches. I had a CT scan of my sinuses which showed only mild to moderate mucosal thickening. I had FESS bilateral unicectomies, middle meatal anthrostomies and anterior ethmoidectomies.

I wish I never had the surgery done, the salty drainage is so bad, I’m constantly coughing in tissues and have a constant high-pitched ringing in my ears. I have really bad anxiety and depression since the operation. I feel so ill everyday. I’m 22 year old female and it’s ruining my life.

I think I might have a csf leak. Had beta 2 transferrin test, which came back negative. I coughed the fluid from the back, I dont get any out the front of my nose. My recent CT scan doesn’t show any evidence of a leak. Been tested for allergies and am not allergic to anything.

What can I do? Thank you.

Answer

Thanks for your note.

It is really hard to let you know without a complete examination, and it sounds like you have been cared for appropriately without the results one would really hope for or expect.

I definitely would suggest further evaluation for csf leak or increased intracranial pressure.

Any medications you are taking need to be looked at. At the NY Sinus Center, we would also look whether there is Gastro esophageal reflux as high as your sinuses causing these symptoms, usually by Restek pH monitoring in the nasal cavities.

Unfortunately, very often sinus problems are complex, rather than straightforward, and treatment really requires understanding the cause of one’s problems.

Robert Pincus MD

Co-director NY Sinus Center

Let’s clear things up

Q & A

Developed Sinusitis After Lefort Procedure

Question: Hello, I have been experiencing sinus problems after undergoing jaw surgery last year. I had a Lefort 3 procedure for temporomandibular joint dysfunction (TMJ) and a maligned jaw in October 2014. Almost immediately after surgery, I felt a tract from my nose running into my cheek, and my cheek on that side of my face was definitely more swollen. Then I developed a case of sinusitis and have been on numerous courses of antibiotics since then, with little or no relief. Due to my post-surgery issues, I have seen 2 ENT surgeons to get some answers and help, as I need relief from this. I had two endoscopy sinus biopsies done and both came back negative. After everything, I now have pressure and pain on my nasal bridge. I still just don’t feel well and have been experiencing sinus headaches.

Can you suggest anything? Even possibly consider a second opinion? I have had an endodontist visit to check out my root canals and they came back fine. I also have had two CT scans done, and they both were apparently negative. Please help me!

Answer:

Unfortunately, it is difficult to give you a definitive answer to why this has happened without performing an in-person evaluation and looking at your medical history. However, complications and sinus problems after jaw surgery, such as sinusitis, can occur. But the answer as to why this happens also varies on the individual and the variables at hand. I would suggest another ENT and possibly get an OMFS consultation/opinion. If you are in the New York City area I suggest seeing Dr. Robert Pincus or myself (Dr. Scott Gold) at our practice. If you are not in the New York area we might be able to suggest an expert closer to you.

Hope this clears things up!

Scott Gold, MD

The New York Otolaryngology Group

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 severe sinus headaches and my doctor is considering balloon sinuplasty

Question: I have been dealing with terrible headaches for a long time. I went to the emergency room roughly 9 months ago with an excruciating headache. They did a CT Scan and found that I had chronic sinusitis and a small retention cyst in my right maxillary. I followed up with an ENT who is trying to treat it with nasal sprays. Months later I felt some numbness above my left eye and had another CT scan which still proved chronic sinusitis but nothing wrong with the brain. It is now August and my symptoms: daily headaches, pain between eyes and top of the head and temples, still are present. It is truthfully affecting my life and I can’t stand the pain. My ENT mentioned a balloon sinuplasty but is now telling me it would have to be proven for me to have the procedure. Please help because this pain is awful.

Answer: Thank you for your question.

Headaches are always a difficult problem. While sinusitis may be the cause of headaches, there are many other types of headaches that can be excruciating and difficult to manage as well. It would be important to see what your sinus CT shows. Should there be significant or persistent inflammation in your frontal sinuses (the sinuses in the forehead), then balloon sinuplasties may be helpful for you. In balloon sinuplasty, the doctor places a thin wire into the opening of the sinus- then inflates a balloon for about 10 seconds. This results in a wider drainage site for the sinuses- and should alleviate frontal sinus infection. It is done in the office, with local anesthetic- and there is virtually no downtime. We do this frequently here at the NY Sinus Center and you can read more about it on our site, nysinuscenter.com

However, as you can well imagine- this will not likely help you if your headaches are from migraines, muscle tension, cluster headaches- or other causes.

Sinus headaches will often respond temporarily to a course of antibiotics and nasal or oral steroids. Migraines may present with visual changes (aura) or respond temporarily to a medication such as sumatriptan taken at the onset of a headache.

We’d be happy to see you here at the NY Sinus Center and help clear things up.

Robert Pincus MD

Co-Director NY Sinus Center

Associate Professor Otolaryngology

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

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

sinus headache Archives - The New York Otolaryngology Group

Salty Post Nasal Drip with Headaches After Surgery

Developed Sinusitis After Lefort Procedure

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

I have severe sinus headaches and my doctor is considering balloon sinuplasty

I can’t breathe from my nose after jaw surgery

Severe Pressure and Pain in Eyes and Head