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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
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Is it Time for Sinus Surgery?
Question: Hello, First off, thanks for taking the time to read and answer. I would like to know is it time for sinus surgery, but please, read my background first.
I have been having sinus issues for about 6-7 years now. At first, I just dealt with it—runny nose, sinus infections, etc. Rarely took anything, just figured it was normal colds.
So after three years or so, I noticed my left nostril would be blocked. It ended up being blocked about 95% of the time. I went to see an ENT. They took a CT scan. Said I had mucus filling all my sinus cavities. They also said I had a deviated septum.
Not real bad except in one area where they said “Severe deviation.” They prescribed Flonase at the time. I tried it, worked OK, but whether it was the medicine, or me just getting worse, my sense of smell and taste really started to go away. I still had a faint sense, but it wasn’t nearly as good. I quit the medication for fear it was the issue.
After another two years of suffering and taking allergy pills which seemed to help (Alegra), I went to my allergist. I could hardly smell at all anymore, and I was getting very depressed about it.
These people were 100% more caring and helpful. They looked at my old CT scan, told me it showed infection, which the ENT never said anything about. They tested me for environmental allergies, and I was basically allergic to everything, pets, grass, dust, mold, trees, etc. But, I rarely get itchy eyes, its just congestion, and constant clear, bubbly mucus.
I blow it out, more there, blow it again, more there. They prescribed Prednisone and an antibiotic to see if we could improve anything. I was also given a nasal inhaler (Q-Nasl). I took the medication, and for the first time in years, I could smell!! I almost started crying. I was so happy.
Well, that only lasted for about as long as the prednisone. I got another CT scan, and they said it was better, but not really much had changed. I still had mucus build up and the infection. Over the course of the last year, I have taken Q-nasal daily. My sense of smell is now essentially nill.
I can’t taste food, and I am at the end. I can’t take it any longer. Over the last three weeks, I have been taking nettle leaf capsules to try and help with allergies if that is my issue. I have even gone through nasal irrigation and the “Friggy Flip Turn” sinus rinse method, Google it if you have never heard of it.
That seems to help clear out all sorts of gunk, but my left side is still persistently closed off. I can breathe easier for sure since my visit last year. Let’s call it 50% blockage of airflow now on the left side. But my smell is gone still.
But keep this in mind…when I eat food or want to smell something, If I blow out of my left nostril, I can usually pick up on smells and tastes. So it’s not gone. It came back with prednisone, so I know its still there. After I blow my nose on the left side, you can even hear like pressure releasing and squeaking. I can feel it happen. It’s like no room for things to go. Like a big build up with only a small opening but lots of pressure. But why can I hardly smell out my ride side? I would figure with one nostril I could still smell a little, but not really.
The question is, is it time for sinus surgery? What else can I do? Will it help bring my smell and taste back? I know there are no guarantees, but is there a good chance that I just have a blockage with my septum, that causes excess mucus and blocks air from traveling to the olfactories? I am thinking of going back to a new ENT and giving them the run through and go from there. At this point, it’s hard to enjoy life.
Answer:
I would suggest that you carefully research the sinus specialist you ultimately choose to do your surgery if it is indicated.
Unlike many other types of surgery, different individuals do sinus surgery very differently. I would suggest seeing someone who practices the most up-to-date type of endoscopic surgery and has a great deal of experience.
Some otolaryngologists are still performing older types of surgery, which are much less successful and in fact, can ultimately lead to more problems than you already have.
I hope this helps.
Scott Gold MD
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What is causing fluid to flow from my nostril?
Question: Once on the first of Oct and again on the 25th of December 2014, I was sleeping and I woke up both times with this fluid gushing out of my left nostril. In June 2014 I fell and had quite a serious fall on my left side.
I had a huge lump on my head and had a J/C shoulder separation. I would like to know what causes this fluid problem?
Answer:
It is possible that the fluid coming from your nostril could be cerebral spinal fluid. This could result from a fracture of the skull base which is the thin bone between the roof of the nose and sinuses and brain.
You should see an otolaryngologist who will most likely ask you to collect the fluid so it can be analyzed in a lab, get CT scan and/or MRI scan and perform a nasal endoscopy. Good luck.
I hope this clears things up.
Scott D. Gold, MD
C0-Director NY Sinus Center
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Is there any reason for septicemia in the condition of atrophic rhinitis?
Question: Is there any reason for septicemia in the condition of atrophic rhinitis?
Answer: Thank you for your question. Atrophic rhinitis, also known as ozena, is a condition in which the nasal cavity loses its ability to serve as a filter due to chronic inflammation of the nose. While atrophic rhinitis is a chronic nasal condition that has an unknown cause, it causes the formation of thick dry crusts in a normally roomy nasal cavity. This is a result of a decrease in size (atrophy) of the nasal mucous lining and the underlying bone. However, while this condition is characterized by the atrophy of the nasal mucosa, it also includes the turbinate bones, the glands, as well as the nerve elements that supply the nose. Normally, the air we breathe in should reach 98.6 degrees F and 100 percent humidity by the time it reaches the back of the nose.
The common symptoms associated with atrophic rhinitis include a runny nose, a stuffy nose, nosebleeds, nasal crusting, nasal deformity, a sore throat, a decreased or loss of smell, as well as frequent upper respiratory infections.
Aggressive surgery, or chronic infection, can cause scarring and the loss of the function of the nose. It can result in crusting, stuffiness, a bad odor and increased risk of infection. Septicemia (a blood-borne infection), while possible, would be quite rare.
Treatment for atrophic rhinitis includes humidification, treatment with ointments and irrigations with a Netti pot or nasal flush. Using nasal irrigation is usually the first line of defense, as this treatment option can help improve tissue hydration and can help reduce crusting in the nose. However, it is important that you irrigate your nose several times a day, and the irrigation solution that you use could be a saline solution, a mixture of other salts, or even an antibiotic solution.
I hope this helps clear things up.
Robert Pincus MD
Co-Director NY Sinus Center
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I had sinus surgery and lost my smell and taste
Question: Hi, I had sinus surgery on all four sinuses along with septoplasty and turbinectomy about a month ago. I completely lost all sense of smell and taste. Maybe once or twice a day I will get it back but very slightly and it only lasts a couple of minutes. My surgeon said it should come back in around 2 weeks and I cannot get an appointment to see him for another 6 weeks. It has now been a month and I am starting to worry. Is this normal?
Answer:
Permanent loss of smell is an uncommon risk from any nasal or sinus surgery. Taste is actually not really involved, but since so much of “flavor” is determined by smell we feel that we have lost taste as well.
It is not unusual for there to be a temporarily diminished sense of smell after sinus surgery as the nasal airways can be congested and there are frequently crusts that keep the flow of air away from the smell fibers, at the roof of the nose. It is likely that is what you have as there are times when the sense of smell returns. Loss of smell from obstruction should resolve and in fact many patients who have diminished smell before surgery will note improvement in their abilitiy to smell afterwards. The much less common loss of smell from nerve damage is best treated earlier, rather than later.
However, most sinus specialists, including us at the NY Sinus Center believe that comprehensive post operative care (including cleanings) is an important part of successful sinus surgery- and will help insure the best results.
I hope this clears things up.
Robert L. Pincus MD
Co-Director NY Sinus Center
Q & A
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Why is there crusting in atrophic rhinitis?
Question: Why is there crusting in atrophic rhinitis?
Answer:
Atrophic rhinitis is a chronic nasal condition in which the nose is unable to function as it should. The nose and the nasal linings takes the air that we breathe and warms it to 98.6 degrees F and 100 percent humidity, by the time the air reaches the back of the nose. However, sometimes the lining of the nose can become damaged and lose this function. As a result, the air then tends to be dry and irritating. With atrophic rhinitis, changes in the function of the nasal passages are caused by the mucosa (the tissue that lines the nose) and the underlying bone shrinking down, causing atrophy of the nasal passages. Typically this condition affects both of the nostrils and can be highly bothersome, even though this is not a life-threatening condition.
Atrophic rhinitis can cause crusting, sinus infections, and nosebleeds. Other common symptoms of atrophic rhinitis include:
Crusting (often green)
Nosebleeds
Nasal discharge
Nasal obstruction
Nasal deformity
Sore throat
Headaches
Bad breath
Strong odor from the nose
Watery eyes
Decreased/loss of smell
Frequent respiratory infections
Atrophic rhinitis can be caused by over-aggressive nasal surgery- especially when the inferior turbinates are removed, medication abuse (too much afrin/neosynephrine, cocaine use and certain infections). While the treatment is difficult, there are a variety of methods available to help treat atrophic rhinitis. Overall, the main goal of treatment consists of rehydrating and re-moisturizing the nasal lining to help alleviate the build-up of crust. The treatment for atrophic rhinitis is extensive and unfortunately, not always successful. In some cases, a variety of treatments are necessary, and they need to be ongoing. When treatment stops, the symptoms typically return.
I would speak to your sinus specialist about your care or visit us here at the NY Sinus Center.
Robert Pincus MD
Co-Director NY Sinus Center
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My nose crusts after resection of my inferior turbinates
Question: I am from the area in Connecticut. I had submucous resection of my inferior turbinates in ’12, as a 27 year old male. Only tissue removed, no bone, anterior to posterior. Since, air flows too quickly, I have dry nasal passages and my nose crusts and bleeds like crazy. It has been the worst decision of my life.
I’m wondering if you gentlemen have seen folks like me, and if you have any experience in implant procedures (alloderm, acell) or PRP application, or if you are interested in exploring regenerative techniques to help those of us with this difficult problem. Many ENTs I have seen post surgery have turned me away.
Answer: I wish I could offer a cure for your problem. We know, that the nose is a filter- and by the time air reaches the back of the nose, the air should be 100% humid and 98.6 degrees. A crucial part of this function is due to the inferior turbinates. These are structures on the side wall of the nasal cavities. At times, though, they can become enlarged and block the airway. When we want to shrink down these structures, we now know that it is important to keep their mucous membrane (outer surface) intact, and just reduce the inside tissue.
If the mucous membranes are lost- either through surgery, infection, or trauma- it is hard to replace effectively. One name for this is the “empty nose syndrome” which manifests as dry nasal passages.
We usually find that moisturizing the nasal cavities with topical ointments at the tip and saline drops- and sometimes a nasal atomizer (mist)- helps the vast majority.
I have not seen any surgical procedure really help- although many have been tried and reported- and we’d be happy to review your options with you personally at the NY Sinus Center.
I hope this clears things up.
Robert Pincus MD
Associate Professor Otolaryngology
Co-Director, NY Sinus Center
Q & A
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I have nasal polyps and need sinus surgery
Question: I have a diagnosis of a nasal polyp of the left nasal passage. I scheduled for a CAT scan and was told will probably need surgery. Most comments from patients who have had this type of surgery have very negative about post-op comfort and length of recuperation. Are there different surgical procedures which would result in less negative feedback? How frequently do nasal polyps grow back requiring repeat surgery?
Answer: First of all, thank you for your question. Nasal polyps are growths in the nose and sinuses that can block both the bleeding and the sinus openings. This can make breathing through the nose difficult, exacerbate asthma and lead to chronic or recurrent sinus infections. We try to get the nasal polyps to shrink down medically so that the symptoms improve. If we are successful then the surgery is not usually necessary. However, when the symptoms persist we do recommend endoscopic sinus surgery as an adjunct to ongoing care. Nasal polyps are frequently caused by allergies but can also be caused just by other recurrent infections or sensitivities. Unfortunately, surgery does not cure the underlying problem and polyps can recur. Postoperative care is quite important to lessen this possibility.
Today, endoscopic sinus surgery is done with minimally invasive techniques. We almost never use packing in the nasal passages today. Often, we can use balloon sinuplasty to open the sinuses which is much less invasive than other techniques. The procedures are done with image guidance- sort of like a GPS for the sinuses- which allows us to see real-time where we are on your CT scan- with submillimeter precision. We are using drugs including stents after surgery in many patients which further improves their course. With such techniques, most patients do not really complain of much pain after surgery.
We would be happy to see you at the New York Sinus Center and review what your options may be.
I hope this clears things up.
Robert L. Pincus MD
Co-director New York Sinus Center
Q & A
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I lost my sense of smell and taste- what can I do?
Question: I fell and I hit head on radiator, blacked out, hospital was vague and unhelpful, found that I have loss of smell and taste from trauma. Can you help? I have some taste of salt. It depresses me. Nobody seems to know anything about this, have any serious ideas. Everybody wants to meet me and charge for consultations. Stupid I am not. But tired of USA doctors. In other countries they will at least say “nothing known about cures for this” but here I get “buy this, eat that” – trivia, as if it were a minor issue.
Answer: Loss of the sense of smell (anosmia) is a major problem, as you well know. It is important for our safety (spoiled foods, smoke, gas) and for our enjoyment of every day life. Loss of smell can be a predictor of neurologic diseases, such as Parkison’s and early dementia.
We at the NY Sinus Center, take the loss of smell as a serious problem and are working to help people like you with the loss of smell and taste.
It is important to find the cause of one’s loss of smell- in this case it seems likely to be the head trauma.
Recent research has shown that early treatment may be beneficial. Studies have shown that in some cases, treatment of sinus disease may help and prednisone early in the loss may be effective. Some newer therapies that we are using include theophylline nasal sprays and smell therapy. They may be effective in later stages, but as time goes on, any treatment is less likely to help.
I wish we could say that a particular therapy will be effective in any individual- specifically in your problem.
I am attaching a power point of a recent continuing medical education lecture I gave to Ear Nose and Throat specialists on this problem.
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.
Will balloon sinuplasty help my runny nose and deviated septum?
Question: I was diagnosed with a chronic runny nose due to having a small nasal opening for drainage and a deviated septum. Am I a Balloon Sinuplasty candidate?
Answer:
Balloon sinuplasty is a wonderful new technique for opening the sinuses. Sinuses are small air filled pockets around the nose that drain into the nose. If blocked, we can get recurrent infections of the sinuses. Balloon sinuplasty is a non-surgical technique in which we find the opening of the sinus, thread a small catheter into the opening, and then briefly inflate the balloon- widening the drainage site. We then remove the balloon. The results have been excellent with this procedure. There is no down time and sinuplasty is done in the office with just a local anesthetic.
You can read more about this on our web site- below
Unfortunately, to date, we have not been using balloons to straighten a twisted (or deviated) septum. The septum is the center wall of the nose, and while it is never straight, a significant bending or twisting can block up the nasal passages or even make one more susceptible to sinus infections.
If the sinuses are sinuses are blocked, then sinuplasty may have a role in your care.
If you’re in the NY area, we’d be happy to evaluate you and determine if you are a good balloon sinuplasty candidate, here at the NY Sinus Center.
