Sinuses

[hugh flung_dung]

I'm starting to wonder if I have a chronic sinus problem.

I have a semi-permanent post-nasal drip and occasionally during rapid descents (eg 7000 to 1000ft) get a pretty severe pain across the lower forehead, over the eyes. It seems like the Valsalva manoeuvre helps at the time but a slightly bruised feeling can last for a day or so afterwards.

Recently I had a fast jet trip, and as soon as the pressurisation came on I suffered a very sharp localised pain just at the top left side of the nose. I managed to clear it but there was a slight problem throughout the trip and it got bad again during circuits.

Occasionally I suffer from pain around the L eye and in front of the L ear for no particular reason. Finally, another piece of (possibly non-related) info is that many many years ago I had my L cheek put back into place after a motorcycle accident.

I'm starting to put all this together and wondering whether it adds up to a sinus problem, or maybe some latent issue from the cheek repair all those years ago. Any opinions or suggestions from the knowledgeable?

HFD

[Pontius Navigator]

Hugh,

I would agree with your thoughts. The entry to your sinus cavity is at the top of the cavity. If you walked like a dog then it would be at the bottom. That is its original design and it would then free drain. In a human it is all wrong.

There is a simple corrective surgical procedure - a bore out - which thankfully I have not needed. Speak with your doctor; may be drop him a note first which would give him a chance to read up on it if need be.

[gingernut]

I'm always a bit concerned about jumping in with surgery, I'd agree, have a chat to your doc first.

I guess your treatment would depend on the duration, intensity and frequency your of symptoms, I'm just wondering if a more conservative approach may be worth trialling first.

From what I can see, the boring out approach seems to work for a while, but eventually symptoms do tend to return , although I'm told the laparoscopic techniques available today, result in faster post op recovery, with less complications

Could always do nothing, and review in 3m.

(Noticed how many sinus problems posted on M&H this time of year).

If you fly planes, then I guess at the very least you need some form of imaging to the region. If you sit in an office then you can probably afford the watchful waiting game:)

[Pontius Navigator]

gingernut, we think alike but if needs must.

Now a regular swim in a nice clean swimming pool then hang your head over the side and let the sinuses drain naturally.:}

Seriously, I used to do reasonably deep snorkel dives for an hour or so. Later, in the bar say, I may bend over and there would be a great gush of water out of my nose 'yuk', but at least I knew the sinuses were running free.

[gingernut]

Yeh, had an ent chap telling me the benefits of a saline washout recently.

I must say, probably get any more washed out than on me surf board at Watergate Bay , but whenever I surf, and tumble, I seem to get terribly clogged, the only relief I get is by lying on a desk, head dangling down, whilst I thump the side of me head with the palm of me hand.

Probably not based in science, but it's great to see the trickle of ocean fall onto the carpet!

The swimming thing only works if I don't put me head under.

[Hufty]

Yes be careful of surgery - they may decide to open out the passageways but there is a risk that the increased airflow can cause the nasal lining to dry out too much - this (as far as I have been told) causes irritants and pollen etc. to get past the lining up into your hooter and makes your symptoms worse.

Nasal washes are great - please try this first. Do a search on Google for "Neti Pot" you don't need to buy one as you might have something around the house that will do the same job but you'll get the idea.

[Dan Winterland]

It is possible that if the problem has occurred after flying with no problems that you have suffered a sinus barotrauma. Equalisation problems can pull the lining of the sinus away from the bone and cause one of several problems. One, it may not re attach and as it's a mucus membrane, it can then be over active. Second, it may not gow back properly and a growth, or 'polyp' may obstruct the opening. Last, it may get infected.

An ENT specailist is your best solution.



As an aside, I know a guy who doesn't have sinuses. It occurs in a very small percentage of people apparently. Lucky guy!

[kingoftheslipstream]

h f d

I have two friends who've had the bore out - it's been a year since for the first guy and no recurrence... the other chap was a bit more recent but he's doin' fine so far.

I have had a serious bout of sinusitis which cost me a few sick days some time ago an' what I do fairly regularly now is hit the sauna at my fitness centre where there is a pleasant concentration of menthol or eucalyptus which stimulates the sinus and bronchi... I view this, personally, as a kind of preventative measure and it seems ta be workin' well for me.

I suspect yer in the UK? Years ago whilst working with the RAF I had a bad cold and got given a thing I 'member was called karvol - it was a little brown gelatine capsule containin' a strong concentration of menthol (I think). The Doc told me ta put it in a pan of very hot water, put a towel over ma head and inhale deeply and often for 10 minutes or so... it does wonders for the sinus and you don' have ta go to the gym and git yer trunks on for a sauna, ya' kin do it in the privacy of yer home.

Another good preventative solution is the ol' standy Otrivin... coupla squirts before a sortie in each nostril and it really cuts down on the sinus distraction and helps valsalva be more effective... I keep one in ma briefcase these days, just in case...

Good luck, 'n keep the shiny side up!
k-o-t-s

[hugh flung_dung]

Thanks for all the advice, although as with most things medical I'm beginning to wish I hadn't asked!
I like the idea of forewarning the GP with a short note and then asking for a referral to an ENT specialist.

HFD

[gingernut]

I think the notes a good idea.

GP's do tend to have differing thresholds for referral, most who've got anything about them try their hardest to keep you away from the hospital!! (cos they care:))

Remember to stress the effect and affect of the job of flying planes. If that fails, keep going back.

Don't walk in with a print-out from the internet, he's likely to have a breakdown:)

[Pontius Navigator]

The reason I suggested pre-warning the GP was the result many years ago of a visit to the civilian medical practioner at a military base.

I had a streaming cold and there was only one sensible solution and at my early stage of training I knew it was not to fly. The totally out of it doc OTOH decided I was fit to fly and should have some nasal drops in case I got a blockage.

I was duly issued with a bottle and a pipette, the sort that you put in the liquid, press your finger over the end, put your head back and deliver a drop in each nose.

The only problem was I was to fly in an unpressurised aircraft, at 39000 feet, would be wearing gloves and holding chart, pens, board etc and have nowhere to put the bottle, cap, or pipette. As my ears would potentially get blocked in the descent - about 3000 feet per mile - and we had no spare fuel to climb back up again it was a load of :mad:

My instructor agreed and I was grounded.

[BAMRA wake up]

Some low tech changes which might help: buy a new pillow, even clean but older pillows a can have a mite population, the gas from their dung is an irritant. Sleep with a slightly open window if the British weather allows!

Some years ago I went to the doc with chronic sinusitis. Based on my flying, recreational diving and El Greco facial shape he said 'probably not much you can do - long sinus passages' then offered a 7 day course of antibiotics to clear up a possible 'residual infection'. It's often the passages that are inflamed rather than the sinus chambers proper especially if you're born with them narrow.

I'd recommend exposure to a warm, sunny climate, it does work! If you ever have a layover in Finland, try a proper hot, dry + steam sauna - works wonders too.

[The Right Stuff]

Dan Winterland:

If, say, a sinus barotrauma has been suffered, and the sinus membrane has become detached from the bone, do you know

1) what this might look like on a CT scan
2) how long before the membrane re-attaches
3) how long before the mucus membrane stops being over active

I think you might have nailed my problems in one since they've occurred after flying with no problems.

Any thoughts/comments much appreciated.

[Rugbyears]

If one dose indeed require a surgical procedure, will they then be subject to licence restriction - Obviously, there is an obligatory requirement to inform the CAA, however, is there a potential possibility that one may see their licence withdrawn or permanently..? :eek:

[Hufty]

You do need to notify the CAA, and they will render you temporailty unfit to fly. However, they will ask you to "self certify" which means you can just return to work when you're better without any additional contact with the CAA or any paperwork.

If your case is slightly more complex then there may be some additional stuff (see your AME) but probbaly not.

[DX Wombat]

For heaven's sake! Start with the simple stuff! Ask your GP to do your IgE levels especially for dustmite and other allergies. Having had problems with stuffed-up sinuses for several years I came to the conclusion that it might just be an allergic reaction to something so went and had a chat with my GP. The IgE levels came back at more than 6 times the upper limit of normal for dustmite. I now take an approved (by the CAA) antihistamine and very rarely have any problems even though the last IgE level was approximately x12 the upper limit of normal.