Dr. Akshay. B. K.
Otolaryngology (E.N.T)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 37-year-old female with a history of chronic rhinosinusitis with nasal polyps for the past 12 years. My current medications include Mometasone and Flixonase drops and Cetirizine. I underwent CT scans in the last year and this month, during which I was informed that surgery is not required, which is a positive development. Upon comparing the scans, I noticed an area near my eye that seems to have increased in size. I am concerned about the potential impact on my eye in the future and whether my ENT specialist compared it to the previous year's scan. I have attached both CT scans for your reference. I am worried about this. Should I consult my doctor regarding this? Please clarify.
Thank you.
Hello,
Welcome to icliniq.com.
I would be glad to help and address all your concerns.
After reviewing both of your scans (attachments removed to protect the patient's identity), I am pleased to report that they appear quite satisfactory, and there is no need for worry. You are exhibiting minimal signs of chronic rhinosinusitis (CRS), and the steroid drops you have been using have yielded very positive results. These drops act exclusively on the nasal mucosa and do not get absorbed into the bloodstream, which means they are quite safe.
The area you have highlighted is the uncinate process on the right, with a small polypoid thickening. This, too, is entirely normal, and your sinuses are well-ventilated, with the OMC (Ostio-meatal complex) functioning properly. In reality, the eye is anatomically quite a distance from this area, so there is no cause for concern.
I hope this answers all your questions.
Thank you.
Patient's Query
Hello doctor,
I appreciate your response.
I am planning to continue using the nasal steroids as recommended. Regarding the CT scans, I am curious about whether there is a clear improvement from last year. Since CT scans consist of numerous slices, I wondered if one might provide more detailed information than the other. For instance, I noticed that I can see the shape of my mouth on one scan but not on the other. I hope this clarifies my question.
Also, I would like to inquire about the safety of mixing mometasone spray with isotonic saline for long-term use. In the past few months, when not using the flixonase drops, I have been using mometasone in the evening, and every morning, I mix one spray of mometasone with saline and apply it in my nose. It seems to reach my sinuses more effectively, but I want to ensure it is safe for prolonged use. I also approached my ENT specialist about prescribing Pulmicort Respules to mix with saline, but he declined, mentioning concerns about systemic absorption. Please clarify.
Thank you.
Hello,
Welcome back to icliniq.com.
As you correctly pointed out, a single film does not provide detailed comparison information, but as a physician who regularly reviews numerous scans, I can confidently say there is a noticeable difference between the two scans. I would suggest you consult your specialist doctor.
It is perfectly fine to mix saline with steroid drops, which is beneficial as saline possesses hygroscopic properties that can enhance mucociliary clearance. When using Mometasone or Budecort (Budesonide) as nasal sprays or washes, there is virtually no systemic absorption to be concerned about. So, you can continue using them without worry.
Thank you.
Patient's Query
Hello doctor,
I just wanted your opinion on something I have noticed lately. I had increased discomfort in my nose five days ago, and although I could breathe out of my nostrils I felt a sense of fullness and discomfort. Around the same time I developed a fullness and difficulty hearing in my left ear, this has now resolved. However, the discomfort in my nose continues. I am wondering what are these lesions is it a bacterial infection in my nose?
Hello,
Welcome back to icliniq.com.
As I can see in the scans the area you have marked is called the uncinate process. There is a small mucosal thickening. It is of same as the size last scan. You need not worry it is not close to your eyes and it is not going to increase in size so please do not worry.
Patient's Query
Hello doctor,
However most recent question is asking about new symptoms, please could you answer this. Please see my recent question which I posted.
Hello,
Welcome back to icliniq.com
The current situation you have described seems like you underwent a viral cold due to which you had an episode of ear infection which has gradually resolved. The nasal pictures that you have sent although not clear are just the effects of post-viral infection. That is absolutely nothing to be concerned about. Please use saline nasal sprays with steroids that should heal all those. There is no nasal bleeding.
I hope this helps.
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Otolaryngology (E.N.T)
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