Q. I get runny nose with small bony defect in ethmoid region. Do I need surgery?

Answered by
Dr. Mohammed Osama Aboborda
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Nov 27, 2020

Hi doctor,

Frequently, I have water coming from the nose for the past 3 months. CT scan result shows an S-shaped DNS more towards the right and left inferior turbinate hypertrophy. There is a small bony defect in the roof of the right ethmoid sinus region with adjacent mucosal thickening. There is mild mucosal thickening in the left maxillary, right ethmoid and frontal recess region. Do I need surgery? What could be the accuracy? Can I have side effects? Please help.

#

Hi,

Welcome to icliniq.com.

Sure, you need surgery to correct DNS (deviated nasal septum) or to resect hypertrophied turbinate, and to close the bony defect. The operation has a high success rate, as it will be an endoscopic nasal operation. There are some complications such as bleeding, orbital fat herniation, orbital hematoma and injury of the brain as the defect is at the base of the skull. Do not get panic. All these complications are rare when done under a well-trained surgeon. Please send your CT scan report.

Thank you doctor,

I am attaching the reports.

#

Hi,

Welcome back to icliniq.com.

If you have normal breathing with no problems with inspiration and snoring, so you can avoid surgical correction of your septum. Also, you can use intranasal corticosteroid spray for hypertrophied turbinates. The surgery is optional for DNS and hypertrophied turbinates. But the bony defect in the roof of the ethmoid must be corrected surgically, and it is not optional. Until you undergo surgery, you have to know about the precautions. Avoid sneezing, cough, straining, crying and anxiety. Even if you have to sneeze obligatory, you have to open your mouth while sneezing to make sure that the pressure comes out from the mouth.

Thank you doctor,

I do not have a breathing or snoring problem. I am not sure whether I need surgery. Please suggest. Does the CT scan show a bony defect? I am not getting proper sleep due to running nose. Please recommend some medicine to avoid it.

#

Hi,

Welcome back to icliniq.com.

Please say whether you analyzed the secretion coming from the nose. If it is mucosal nasal secretion, then the treatment is an intranasal corticosteroid. If the fluid is cerebrospinal fluid, it comes from the bony defect, and the only remedy is a surgical operation to close the existing defect. I studied the scan carefully, and I can see the small bony defect.

Thank you doctor,

I would like to know whether the surgery can solve my problem 100 %. Can I have side effects after surgery? How many days will it take to come back to normal?

#

Hi,

Welcome back to icliniq.com.

If the nasal discharge is cerebrospinal fluid, it comes from the bony defect, and the surgery will completely solve the problem. If the nasal discharge is a mucus, then the dental and turbinate surgery can decrease the symptoms. But it will not solve the problem completely. The side effects are profuse bleeding due to an injury of any main blood supply, orbital fat herniation, orbital hematoma and cerebrospinal fluid leak due to iatrogenic meningeal injury.

All these previous side effects are uncommon with a well-trained surgeon. You can leave the hospital in two days, and you need complete rest for a week at home under medical treatment. Go ahead for surgery to close the defect. Septal and turbinate surgery is not mandatory especially, as you do not have breathing problems.

Thank you doctor,

What type of surgery is recommended to close the defect?

#

Hi,

Welcome back to icliniq.com.

You need functional endoscopic sinus surgery. This surgery is performed with the help of endoscopes. So there are no external incisions. Usually, the defect is closed by a fatty tissue or synthetic cement according to the size of the defect and the surgeon choice.

Thank you doctor,

How soon we need to do this surgery? Can we take three to four weeks time?

#

Hi,

Welcome back to icliniq.com.

Do it as quick as possible. Today is better than tomorrow. Till the time of surgery, avoid straining, sneezing, coughing and anxiety.

Thank you doctor,

I think I have this problem due to a bike accident that happened before three months.

#

Hi,

Welcome back to icliniq.com.

Yes, it can be the main cause.

Thank you doctor,

Please let me know if anything else that I need to take care. I am going for surgery. Do I need any special checkups?

#

Hi,

Welcome back to icliniq.com.

You need to do liver and kidney function tests, bleeding profile, electrocardiogram, complete blood picture, fasting, and postprandial blood sugar.

Hi,

Surgery has been scheduled for tomorrow . Could you please review attached latest results. She has Sinus and 2mm bone defect.
# welcome again. the MRI shows the same defect with cerebro spinal fluid leak plus brain tissue herniation. it means there in a minimal piece of brain comes out from the bony defect
She has Sinus and 105 sugar . Would that be a problem for surgery? Also she was strained due to work pressure and tensed.
# no... no problem. best wishes for you all
Thank you!! I will be in touch with you.
# I'm waiting to hear from you.
Hi Doctor,

Surgery has been done . However she feeling still pain and fluid is coming. Its been 1 week hat surgery completed. Doctor gave attached prescription. Not sure about the result of surgery. Please let me know if that is common.
# welcome back. continue the treatment it is excellent. another mri should be performed again after at least one month from surgery to evaluate the result of the surgery. the patient must avoid straining,sneezing,constipation and cough
She got cough immediate after surgery due to nose closed. Would that cause any issues. Is there any medication to avoid sneezing. She has dust allergy which causes frequent sneezing which can not stop. Please let me know if any other advices to avoid sneezing.
# she is already taking antihistamines that reduce sneezing. all we can do is to avoid allergens as dust

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