Q. My salivary gland is blocked. Is it related to silent sinus syndrome?

Answered by
Dr. Mehak Agarwal
and medically reviewed by iCliniq medical review team.
Published on Jun 27, 2018 and last reviewed on: Nov 07, 2019

Hello doctor,

I went to the ER for a painful gland. It turned out that I have a blocked salivary gland.

When the CT scan was taken, there were notes in the report about silent sinus syndrome and other things that were never even brought up to me.

I have uploaded the report. Is there anything in this that would cause worry?

Dr. Mehak Agarwal

Diabetology Otolaryngology (E.N.T)
#

Hi,

Welcome to icliniq.com.

I have seen the attached report (attachment removed to protect patient identity).

There is a calcification in the left submandibular gland, which needs to be removed, as it is troubling you.

Silent sinus syndrome is due to maxillary sinusitis, which involves the orbit without any symptoms.

Do you have any double vision or any other symptoms in the eye? Do you have any facial pain or recurrent nasal infection or excessive sneezing?

Can you please send images of your scan. Also, if you have any eye symptoms, you should get an ocular examination done by an ophthalmologist.

Revert with more information to an ENT otolaryngologist online --> https://www.icliniq.com/ask-a-doctor-online/ENT-Otolaryngologist


Hello doctor,

Thank you for replying. I have attached my scans. My symptoms have been a post-natal drip, and I have had some pain behind the right ear.

The first doctor which I saw, blew it off as Eustachian tube infection without any testing. Apparently, the right side of my throat also has a bit of cobblestoning appearance.

I have not noticed my eyelids looking droopy, but they do feel a bit heavy to me. I also have been having pressure headaches.

Dr. Mehak Agarwal

Diabetology Otolaryngology (E.N.T)
#

Hello,

Welcome back to icliniq.com.

I have gone through the CT films (attachment removed to protect patient identity).

While the immediate concern is due to the stone, which I am sure the doctors are doing their best to manage, three other findings raise our concern.

One, the silent sinus syndrome, which is the bowing of maxillary sinus walls due to a long-standing inflammation. A long-standing chronic inflammation could have resulted in the bones of maxillary sinus become weak. The floor of the orbit and roof of the maxillary sinus are the same bone.

Atelectasis of that bone results in downward bowing of the sinus wall making more space for the eye and the eye getting displaced backward without any symptoms or pain. The long-standing inflammation in the sinuses is the reason for your post-nasal drip. Increased mucus from sinuses can obstruct the Eustachian tube on their way to nasopharynx from the nose and cause the symptoms in the ear, like pain or block or reduced hearing. Your doctor is right in that.

Chronic inflammation of sinuses producing such a constant drip down the throat can cause edematous bulge of granules in the posterior pharyngeal wall, which you refer to as cobblestoning. The same can cause edema of vocal cords combined with any acidic reflux which goes hand in hand. This is the second concern, the pharyngeal congestion and edema.

The third concern is the deviated nasal septum. It has deviated so much to the left that it impinges on the left turbinate. Such a persistent nasal obstruction can contribute to the symptoms like nose block, constant post-nasal drip, throat irritation, snoring, mouth breathing, cobblestoning, etc. This also has to be corrected.

There are no findings in the ears in the scans that you have shown me. They appear normal. The aeration, ventilation, and spaces appear inside both ears.

Ideally, after your salivary gland stone problem is solved, I would suggest you start using an anti-inflammatory medicine like Mometasone furoate or Budesonide inside the nose. Nasonex 50 mcg (Mometasone furoate) is enough. I suggest taking two puffs in each nostril and do not forcefully inhale after that. Take the puffs in morning and evening for two weeks. If you find improvement, you may continue it for 4 to 6 weeks.

However, if you do not find improvement using the spray, you will have to undergo a nasal endoscopy in the hospital. Depending on that, we may plan for a minimal endoscopic sinus surgery and correction of septal deviation. If gross facial asymmetry is present, then along with sinus drainage and ventilation, we may add some implant in the floor of the sinus to lift it up and push the eye slightly outward to correct the enophthalmos.

I hope this clears your doubts regarding the CT scan. Do revert if you have any further query. Will be happy to help you.

For more information consult an ENT otolaryngologist online --> https://www.icliniq.com/ask-a-doctor-online/ENT-Otolaryngologist

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