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Sinus pain


Airway obstrucion



We expect our sinus doctor to hear our story, look into our nose, and figure out what the problem is. I wish it was that easy. Your doctor can not see into your sinuses unless you have had sinus surgery. Even in patients who have had sinus surgery, only the sinuses that were opened are amenable to examination with an endoscope.

CT scans are the most valuable tool for adding some certainty to the diagnoses. CT scans clearly define the anatomy and show any anatomic abnormalities. Scans can show the location and extent of infection or swelling. They demonstrate polyps and cysts if they are present.

When patients are initially diagnosed with chronic sinus problems, the diagnosis usually hinges on "educated guessing". Based on the history, the nature of the symptoms, and the physical exam, your doctor will guess as to what is going on. In some cases the diagnosis is fairly certain, in other situations there may be a few possibilities.

Treatment is begun on this presumptive diagnosis, and if problems don't respond in the usual fashion then it is necessary to be more certain about the diagnosis. In this situation, there is no test that is as helpful as a CT scan.

Some thoughts about CT scans for sinus disease:
  • The "Limited Coronal" scans that I typically order costs about $350, insurance usually pays the bulk of this fee. Plain sinus X-Rays can cost more, depending on where they are done, and they do not provide as much information. Some physicians will order a comprehensive CT scan of the sinuses, this is not necessary in most cases, it costs much more, and has additional radiation exposure. The more comprehensive scans are needed only for pre-operative planning of complicated sinus surgeries.
  • CT scans show some of the sinuses that plain X-Rays do not show well.
  • Dye is not used in CT sinus scans, the procedure takes about 10 minutes, the radiation exposure is minimal, and the findings are often instrumental in arriving at a solution for difficult sinus problems.
When should the doctor consider obtaining a CT scan?

There are several factors that go into the decision to order a CT scan to evaluate sinus problems. In general they are reserved for patients with symptoms that are frequent or severe. They are especially useful if treatment isn't going well. Sometimes treatment doesn't go well because the diagnosis is incorrect. The CT scan can help provide a more certain diagnosis in many cases.

These are the most common situations when a CT scan is helpful
  • After prolonged antibiotics given for a chronic infection to see if the sinuses have fully cleared. At this juncture, depending on the situation, the patient may be best served by prolonging the antibiotics, considering surgery, or simply staying on steroid sprays. The CT scan findings help with this decision.

  • When headaches that might be of sinus origin do not respond to the usual measures, a scan can help give some direction. If the CT scan doesn't show a sinus based explanation, the patient is usually better off trying standard headache medicines. If a blocked or infected sinus is found, additional sinusitis treatment is recommended.

  • In the evaluation of smell abnormalities like loss of smell.

  • In patients who very frequently have symptoms of sinusitis and do seem to get full relief with antibiotics and other sinus medicines. It can be helpful to obtain a CT scan during one of the flare ups to see just what is really happening during this time.

CT scans are an important
diagnostic tool.

Knowing when to obtain this
study is one key to efficient
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