Otitis Media NOS - New Diver Needs Help!

[DandyDon]

It's tempting to tell a diver that what works for me should work for him - but not necessarily true to be sure. If it were, we wouldn't need doctors - just pass the words among each other. We're fortunate that we do have such a good medical system and such giving volunteer physicians here on SB.

good luck...!

 

[TheBigPhillyFish]

OK, I REALLY am going to go out on a limb here and break one of my rules, which is to never reassure ANYONE over the Internet. But I do think that a little perspective here would be helpful. Please promise me that you understand that I'm just talking in general terms here, and not diagnosing or treating you myself, you need to go over the scan with the doctor who ordered it...



The paranasal sinuses are air filled spaces surrounding the nose and draining into the nasal airway. There are four "sets" of sinuses: The maxillary sinuses (the big ones in your cheeks), the ethmoid sinuses (the little ones between your eyes), the frontal sinuses (in your forehead), and the sphenoid sinuses (deep in the center of the skull).

That is, you don't really do anything about it if it doesn't cause any problems, and the only reason that you know that it is there is because you got a CT scan. In some cases, the polyps can be big enough to cause blockage of the sinus drainage pathways, and thus cause symptoms - this often is helped by surgery in which the sinuses are opened up to drain better and the polyps are removed.

Now, your scan mentions sphenoid sinus retention cysts. If you google sphenoid sinusitis (which I am guessing you did), you will find some very scary stuff. That is because the nerve of vision (optic nerve) and the main artery to the brain (internal carotid artery) run through the wall of the sphenoid sinus. For that reason, an ACUTE INFECTION in the sphenoid sinus is something that needs quick treatment, and can have real complications. HOWEVER, a small polyp or cyst is not the same thing as an acute infection (in which the sinus fills with pus). SO, as with most things, "the devil is in the details". An incidental finding of a small polyp in the sphenoid does not always need treatment at all...

It does worry me that you have such severe headaches, but the way that you describe the symptoms is not that typical for sinusitis. It is also unusual that you just go the report on the scan without any context - did it just get mailed to you or something? It's probably better that you speak with the ENT doctor about the findings - maybe you can call the office tomorrow and ask about them...

The bottom line is that CHRONIC sinus disease (with cysts, polyps etc...) is not really an infection at all, but rather a form of inflammation related to poor ventilation of the sinuses. The fact that both an acute infection and chronic inflammation can look similar on a CT (that is "grey") doesn't necessarily mean that they are the same condition (although there is some overlap).

Whether or not chronic sinus disease needs any treatment is based on the extent of the disease on the CT (your scan was read as "mild") and the clinical context (that is, your symptoms). Have your ENT doctor take a look a the scan and then decide with him or her if any treatment is necessary. I wouldn't think that this would prevent you from diving in the future, one way or the other...

Mike

Dr. Mike, please understand, I know your only giving my general details to put me at some ease, not as any type of treatment or diagnosis. Now that the leagal stuff is out of the way.

I picked up the CD Rom of the scans as per the doctors request. Along with the disk is a small report which was reviewed by a physician. I even looked at the scans myself and you can clearly see the cysts/polyps, there is three of them. The deep one seems to be pretty big, I would say about 40% of the size of my eye in the scan. I would think this is the cause of the severe headaches. I have had two treatments of antibotics and a steroid. Its hard to think there is still infection, but I am still congested, and getting fevers with the headaches. So I am thinking there must still be some residual infection. Its ironic you said you are worried about the headaches, because the ENT seemed pretty concerned about them. Each day they seem to get worst. I have had a few migranes in my day, and they were a walk in the park compared to these things. The last about 1.5 - 2 hours. My normal routine with them, which by the way is every day now. I take 2 tylenol, 2 motrin, very hot shower and then a very hot compress on the left side of my face. This seems to reduce the duration of the headache. As I said they have been getting progressively worst every few days. After the headache, I still feel a lot of pressure in the entire left side of my face. Along with a fever which seems to be mostly on the left side also, eye socket ear lobe and left cheek. After the headache, I am completely drained of energy, getting out of bed or off the couch is a choir, then I think I all a sleep or pass out either or. When I wake after an hour, I still feel slugish but no headache and no pressure. Another note I have a lot of cysts on my body, 4 in my upper torso one on my neck and a few in my thighs (i was told they are lipomas and didnt need any attention). So I really wasent surprised when they said cysts. I would be fine if the headaches werent so dam severe.

The quickest the doctor could see me is Thursday. I have decided, to go with that, but if I get another headache like the one today, I am just gonna head to the ER.

Dr. Mike, When I go to the ENT what kind of questions should I ask? Is this something that can wait till Thursday, or should I insist on seeing him asap? Oh yah, I do have a history of RSD (CHRIPS) so I am thinking surgery will not be an option for me!

Well Dr. Mike, thanks for everything. You have helped me more then you can imagine. Just having the ease of mind can make all the difference. I will update you as soon as I get the follow up completed. Again Thanks

 

[doctormike]

I picked up the CD Rom of the scans as per the doctors request. Along with the disk is a small report which was reviewed by a physician. I even looked at the scans myself and you can clearly see the cysts/polyps, there is three of them. The deep one seems to be pretty big, I would say about 40% of the size of my eye in the scan.

OK, that could possibly be the cause of the headaches, but again - a cyst or polyp alone without the suggestion of pus (an air-fluid level), is less likely to be causing acute symptoms.

I would think this is the cause of the severe headaches. I have had two treatments of antibotics and a steroid. Its hard to think there is still infection, but I am still congested, and getting fevers with the headaches. So I am thinking there must still be some residual infection.

Cysts and polyps generally do not respond to antibiotics, although if they are causing blockage and an acute sinusitis (pus in the sinuses), antibiotics may be needed. But again, that is usually apparent from the scan... so that might be something to ask the ENT doc.

Its ironic you said you are worried about the headaches, because the ENT seemed pretty concerned about them. Each day they seem to get worst. I have had a few migranes in my day, and they were a walk in the park compared to these things. The last about 1.5 - 2 hours. My normal routine with them, which by the way is every day now. I take 2 tylenol, 2 motrin, very hot shower and then a very hot compress on the left side of my face. This seems to reduce the duration of the headache. As I said they have been getting progressively worst every few days. After the headache, I still feel a lot of pressure in the entire left side of my face. Along with a fever which seems to be mostly on the left side also, eye socket ear lobe and left cheek. After the headache, I am completely drained of energy, getting out of bed or off the couch is a choir, then I think I all a sleep or pass out either or. When I wake after an hour, I still feel slugish but no headache and no pressure.

Yes, that is worrisome. Not exactly typical for what you would see with an acute sphenoid sinusitis, but pain in the head and neck can present in a lot of different ways, and can be "referred" (that is, disease in one place can cause pain elsewhere).

Another note I have a lot of cysts on my body, 4 in my upper torso one on my neck and a few in my thighs (i was told they are lipomas and didnt need any attention). So I really wasent surprised when they said cysts.

Lipomas (benign fatty growths) and skin cysts are really very different from the cysts and polpys that form in the sinuses - one doesn't make the other more likely. They are just both called "cysts" because of the way they look when opened or on a scan, but they come from different processes.

The quickest the doctor could see me is Thursday. I have decided, to go with that, but if I get another headache like the one today, I am just gonna head to the ER.

Sounds reasonable, but if these are truly chronic cysts, they may have looked like that for a long time. On the other hand, something else might be going on causing such severe headaches. It would make sense to be checked out in the ER to make sure that you don't have anything else going on apart from the sinus problems.

Dr. Mike, When I go to the ENT what kind of questions should I ask? Is this something that can wait till Thursday, or should I insist on seeing him asap?

You might want to call the office and ask the staff to see if he can take a look at the scan and see if he wants to see you earlier. I couldn't make that call over the Internet.

When you speak with him, I would ask if the cysts/polyps are clinically significant and if he thinks that they are causing your symptoms. You might also ask if there is any other possible explanation, such as a neurological condition.

Medical therapy doesn't always work that well if there is a large mass of soft tissue blocking the sinuses, but it might be worth asking about that. Some form of surgery may be recommended, but (as I always say here!) "the devil is in the details"...

Oh yah, I do have a history of RSD (CHRIPS) so I am thinking surgery will not be an option for me!

I don't know much about the anesthetic implications of RSD myself, but googling around it seems that there are ways to deal with RSD and surgery. If you truly have an acute process in the sphenoid, you might need to address it surgically after all. Again, speak with the ENT about that.

Well Dr. Mike, thanks for everything. You have helped me more then you can imagine. Just having the ease of mind can make all the difference. I will update you as soon as I get the follow up completed. Again Thanks

Sure..! No problem...

Keep me posted, and hang in there...

Mike

 

[TheBigPhillyFish]

Ok here is where we are. Doctor has issued another round of antibiotic, this time to run for 30 days. He also issued another round of Predisone. Wants to try and treat this lump/mass what ever it is with medicine before any type of surgery. Which it would be nice if the medicine clears it up. The headaches have seem to calm down a little bit, and the congestion doesnt seem to be so bad.

But good news! I am cleared to go back in the water. Which is nice. So I booked my flight back to Florida, gave myself 2 weeks more. Doc just said take it nice and slow, and relax. And I should be in good shape.

So chalk it all up as a learning experience, and remember if you have a doubt you should be in the water, you shouldn't until you speak with a doc. And always get a check up once in a while, especially your nose and ear stuff. You never know might just find an infection that hasen't cause you a problem, like I did. At least till you dive.

Well close this one out, Dr. Mike thanks for everything, your the best!

Kudos for Dr. Mike

Thanks

 

[doctormike]

So chalk it all up as a learning experience, and remember if you have a doubt you should be in the water, you shouldn't until you speak with a doc. And always get a check up once in a while, especially your nose and ear stuff. You never know might just find an infection that hasen't cause you a problem, like I did. At least till you dive.

Well close this one out, Dr. Mike thanks for everything, your the best!

Hey, no problem..! Always happy to help as best as I can... have fun in Florida, and feel free to let us know how things work out with the follow up next month!

Mike