Question:
Hi I have considered this latest suggested procedure long and hard since my ENT first suggested it last autumn. I have had four previous ESSs, which have left me free of any maxilliary or ethmoid sinus problems, but which have been unsuccessful in preventing obstinate frontal sinus infections from recurring – for the whole of this last winter, in fact, I have had acute or subacute infection. My problem is not now anatomic – my frontal ostia have been observed wide-open when I have no infection or inflammation in my frontal recess – but I have hyper-reactive mucosae (related perhaps to very high IgE levels), and I develop extreme frontal recess mucosal swelling and large polyps very easily, which goes down only with high does of intranasal or oral steroids. As soon as I stop taking oral steroids, the polyps/swelling comes back, and the intranasal steroids have begun to cause bad nosebleeds. I have tried just about every therapeutic option there is, and although I would be prepared to give a frontal sinusotomy a chance, my ENT says he thinks it would only provide relief for two years or so before scarring up again. I’m now awaiting a second opinion on the obliteration op from an expert experts’ expert (or, I suppose, a ‘gold standard’ sinus specialist: I have already been passed from my GP to a generalist ENT to a specialist ’sinus endoscopist’ ENT.)
From what I’ve read in the literature,
the chances of long-term relief look OK, once I’m over the horror of the surgery itself. I’d welcome any first-hand experience, however SFL Don Brady <dbr…@pobox.com
wrote in message
news:B1L+Oj5QEneDwuuW2d75b4k=y08L@4ax.com… – Hide quoted text — Show quoted text -
On Sun, 13 May 2001 06:03:29 GMT, "Michael Muloin" <mmul…@home.com
wrote:
Be careful with a frontal sinus obliteration. You may end up with more problems in the long-term than you presently have. This is a procedure reserved only for the most severe cases that do not respond to endoscopic surgery. An endoscopic frontal sinusotomy is a difficult procedure to master, but
it
may be worth consulting with the best surgeons in your case. Including European surgeons, perhaps. I understand the operation may be
done
more frequently there. I would not have it done by someone who was just experimenting with it or learning it.. He should ask.
Response:
Steven My surgeon thinks this procedure has a better-than-80% chance of success. Although I don’t want to have it, I guess a couple of weeks of more intense pain will, in the end, be better than another decade or more of what I’m going though now. I’m still getting a second opinion, though! Do your coughing fits result from an itch in your throat/chest, or mucus buildup or what? Sometimes, normally towards the end of a bout of bronchitis, I get intense itching low in my throat, and real paroxysms of unstoppable coughing that leave me half-suffocated, because I can’t stop coughing enough to breathe. I think. though I only get coughing that bad when the mucus starts to dry up. When my cough is most productive, I cough more to get the stuff up than because I have to… To be honest, I find the whole thing a bit disgusting, and feel like some elderly TB victim, even though I’m only 38 and quite well-nourished! This whole illness bit has completely destoyed my self-image as a fit, healthy adult in the prime of life. It’s hard not to feel bitter sometimes (even though I know I shouldn’t because, hell, it isn’t, like, fatal is is?!). SFL
Response:
suffol wrote:
Do your coughing fits result from an itch in your throat/chest, or mucus buildup or what? Sometimes, normally towards the end of a bout of bronchitis, I get intense itching low in my throat, and real paroxysms of unstoppable coughing that leave me half-suffocated, because I can’t stop coughing enough to breathe.
Yes, that’s about right. What I have figured out is happening, is that the cilia in my airways keep pushing the mucus up higher and higher into the trachea, in an attempt to get rid of it. Eventually the mucus has migrated up into the larynx. And that is what provokes the coughing spasm. My pulmonologist detected wheezing all the way down in my lower lung lobes. So it’s possible that secretions are being generated down in the lungs and then pushed up by the cilia into the trachea.
I think. though I only get coughing that bad when the mucus starts to dry up. When my cough is most productive, I cough more to get the stuff up than because I have to…
By inhaling steam, I realize that the mucus has gotten "stuck" in the larynx, and the steam helps loosen it up to be coughed up. I used to think it was all from post nasal drip, but now I am realizing that the mucus is actually coming up from much lower down in my lungs.
To be honest, I find the whole thing a bit disgusting, and feel like some elderly TB victim, even though I’m only 38 and quite well-nourished! This whole illness bit has completely destoyed my self-image as a fit, healthy adult in the prime of life. It’s hard not to feel bitter sometimes (even though I know I shouldn’t because, hell, it isn’t, like, fatal is is?!).
I’m on Paxil (an antidepressant). — Steven D. Litvintchouk Email: sdlit…@earthlink.net "I guess I could have paid a little closer attention when I was in English class, but it all worked out OK. I’m gainfully employed." – President George W. Bush
Response:
On Sun, 13 May 2001 20:52:45 GMT, Steven Litvintchouk <sdlit…@earthlink.net
wrote:
… What I’m dealing with now, is that my LOWER respiratory symptoms have gradually worsened despite that. Even though I would swear that I don’t have acute sinusitis right now. Nasal irrigation always runs clear, post nasal drip is only rarely discolored (and then only slightly).
I have never had colored drainage and yet I have pansinusitis that triggers a bad cough the more of there is. If I clear out out, by swimming say, the cough clears also. So maybe you still have infected drainage, even though it is clear. I have never coughed up colored stuff either, though.
So why I am now coughing up this yellow-green gunk (in fact I just coughed up some, right as I was typing this message), is a mystery to me. I am convinced it’s not post-nasal drip.
Maybe your sphenoid sinus is draining now. – it has a different drainage path. I’m just guessing though. I would get some more opinions from lung experts.
Response:
- Hide quoted text — Show quoted text -Don Brady wrote:
On Sun, 13 May 2001 20:52:45 GMT, Steven Litvintchouk <sdlit…@earthlink.net wrote: … What I’m dealing with now, is that my LOWER respiratory symptoms have gradually worsened despite that. Even though I would swear that I don’t have acute sinusitis right now. Nasal irrigation always runs clear, post nasal drip is only rarely discolored (and then only slightly). I have never had colored drainage and yet I have pansinusitis that triggers a bad cough the more of there is. If I clear out out, by swimming say, the cough clears also. So maybe you still have infected drainage, even though it is clear. I have never coughed up colored stuff either, though. So why I am now coughing up this yellow-green gunk (in fact I just coughed up some, right as I was typing this message), is a mystery to me. I am convinced it’s not post-nasal drip. Maybe your sphenoid sinus is draining now. – it has a different drainage path. I’m just guessing though. I would get some more opinions from lung experts.
I just saw a pulmonologist at Mass General today. She heard some wheezing in my lower lung lobes with her stethoscope. I gave them a sputum sample with that greenish material, for them to culture. She heard the phlegm "rattling" around in my trachea–she didn’t even need the stethoscope to hear it from a distance. They gave me a bunch of breathing tests, all of which required me to breathe into tubes connected to various machines. All this forced heavy breathing I was doing caused a real disaster. I developed a massive coughing spasm and I was literally on the floor of the lab coughing my guts out. The nurse technicians doing the tests were stunned. I’m curious to see what the culture tests show. — Steven D. Litvintchouk Email: sdlit…@earthlink.net "I guess I could have paid a little closer attention when I was in English class, but it all worked out OK. I’m gainfully employed." – President George W. Bush
Response:
SinusS wrote:
Steve, I had assumed that you are one of the lucky ones who actually had this disease under control (with irrigation and other good things) (based on your messages in the past). I guess I was wrong.
No, you were right–for a while. I had my sinus surgery in August 1997, and my sinusitis had gradually gotten under control. What I’m dealing with now, is that my LOWER respiratory symptoms have gradually worsened despite that. Even though I would swear that I don’t have acute sinusitis right now. Nasal irrigation always runs clear, post nasal drip is only rarely discolored (and then only slightly). So why I am now coughing up this yellow-green gunk (in fact I just coughed up some, right as I was typing this message), is a mystery to me. I am convinced it’s not post-nasal drip. — Steven D. Litvintchouk Email: sdlit…@earthlink.net "I guess I could have paid a little closer attention when I was in English class, but it all worked out OK. I’m gainfully employed." – President George W. Bush
Response:
Boyd Annas wrote:
Bacterial infections in the lungs cause such mucus. Pneumonia for one type. I suggest a quick trip to the Dr. These types of actual infection can do great damage to your lungs, and do it fast. Boyd
What sort of damage? Can the damage be permanent? BTW, I did see a pulmonologist today. The pulmonary function tests she ordered me to perform, required a lot of heavy breathing and panting into these breathing tubes. This provoked such a coughing spasm in me, that I was literally on the floor coughing my guts out. The nurses performing the tests were stunned. I’ve been sucking Albuterol ever since I had those tests this afternoon. — Steven D. Litvintchouk Email: sdlit…@earthlink.net "I guess I could have paid a little closer attention when I was in English class, but it all worked out OK. I’m gainfully employed." – President George W. Bush
Response:
On Sun, 13 May 2001 06:03:29 GMT, "Michael Muloin" <mmul…@home.com
wrote: Be careful with a frontal sinus obliteration. You may end up with more problems in the long-term than you presently have. This is a procedure reserved only for the most severe cases that do not respond to endoscopic surgery. An endoscopic frontal sinusotomy is a difficult procedure to master, but it may be worth consulting with the best surgeons in your case.
Including European surgeons, perhaps. I understand the operation may be done more frequently there. I would not have it done by someone who was just experimenting with it or learning it.. He should ask.
Response:
RE/
What’s a "semi-recliner"?? Is that like a Barcalounger?
I was dancing around trying to describe it…. I’ll eMail you a photo. It’s nothing special, although one advangage is that it’s light enough to move around easily. I even took it to on vacation couple years ago when we drove to Florida. ———————– Pete Cresswell
Response:
Steve, I had assumed that you are one of the lucky ones who actually had this disease under control (with irrigation and other good things) (based on your messages in the past). I guess I was wrong. I am always very interested to read what you have to say. You seem to know a lot about this disease. I hope things get better for you and you continue to provide useful insights to this group. I am doing a little better than your situation. My asthma/bronchitis does remain in control. However, sinusitis/bronchitis seem to happen 6-7 times year. Recovery time is 4-5 weeks. Even in between there is always something minor going on. best of luck. "Steven Litvintchouk" <sdlit…@earthlink.net
wrote in message
news:3AFA213E.D6CF68A0@earthlink.net… – Hide quoted text — Show quoted text -
Suffol wrote: Steve I too have this horrible synergy between sinusitis and bronchitis. With
me, the
way it goes is whenever I get a flare-up of my chronic sinusitis, I get
a dose
of bronchitis too. The phlegm I cough up is precisely the same colour as
the
stuff that comes down my nose (for me, normally a distinctive electric
yellow.
Yuk). Sometimes the bronchitis clears quickly with antibiotics, but
sometimes I
go on coughing stuff up for three weeks or more. The sinusitis never
clears
completely; the best I get is a week of reduced drainage and fewer
frontal
headaches, and then the cycle begins again. I’m never really ‘ill’ with
this,
but I’ve been low-grade sick for almost the whole of the last eight
years. I do
all of the right things, take everything the dr prescribes with
religious
observance, irrigate frequently, and yet I just don’t ever get
completely
better. I’ve had four sets of ESS and am now awaiting a second opinion
on
frontal obliteration. I read in a medical journal recently a description
of
some patients as ‘upper-respiratory tract cripples’, and that’s just
what I
feel like after eight awful years. So; no great advice, but you’re not
alone
either! The problem I’m having is, this mess is interfering with my ability to hold a full-time job. I’ve been out of work a number of times in the last 6 months. If the symptoms you report have not compromised the quality of your life, I truly envy you. — Steven D. Litvintchouk Email: sdlit…@earthlink.net "I guess I could have paid a little closer attention when I was in English class, but it all worked out OK. I’m gainfully employed." – President George W. Bush
Response:
Be careful with a frontal sinus obliteration. You may end up with more problems in the long-term than you presently have. This is a procedure reserved only for the most severe cases that do not respond to endoscopic surgery. An endoscopic frontal sinusotomy is a difficult procedure to master, but it may be worth consulting with the best surgeons in your case. Michael M "Suffol" <suf…@aol.com
wrote in message
news:20010510112556.27272.00000060@ng-fm1.aol.com… – Hide quoted text — Show quoted text -
Steven My quality of life is undoubtedly degraded, to a variable extent depending
on
how bad I am. I have three kids under ten, however, and not working is not
an
option for me. I’m lucky to have an understanding employer who’s more interested in whether I fulfill my job objectives than whether I’m in the office 9-5 every day. Even when my sinusitis/bronchitis is bad, I rarely
get
systemically ill (eg. fevers/muscle soreness, flu-type symptoms), so
although I
feel below-par for much of the time, I’m not disabled by my illness. More,
it
interferes with my personal life. I can’t get physically fit, I rarely
feel
like going out socially, I’ve had to give up choral singing. I would not
be
even contemplating frontal sinus obliteration if it weren’t for these quality-of-life factors. I guess it’s the same for many/most chronic
sinusitis
sufferers. SFL
Response:
"(Pete Cresswell)" wrote:
RE/ Unfortunately, especially with asthmatics, the worst coughing occurs at NIGHT, destroying my sleep, and my doctor never gets to see that. I even offered to take a camcorder and videotape myself coughing at night! Consider trying to learn to sleep sittin in a chair.
That’s a good idea!
The chair I use (when needed) is a semi-recliner.
What’s a "semi-recliner"?? Is that like a Barcalounger? — Steven D. Litvintchouk Email: sdlit…@earthlink.net "I guess I could have paid a little closer attention when I was in English class, but it all worked out OK. I’m gainfully employed." – President George W. Bush
Response:
RE/
Unfortunately, especially with asthmatics, the worst coughing occurs at NIGHT, destroying my sleep, and my doctor never gets to see that. I even offered to take a camcorder and videotape myself coughing at night!
Consider trying to learn to sleep sittin in a chair. The chair I use (when needed) is a semi-recliner. I put my legs up on the bed and lay back about halfway in the chair. In this position I can get a whole nite’s sleep when my bronchs are in a condition that makes me cough my brains out as soon as I lay down. Sometimes I do this for 3-4 months at a stretch. ———————– Pete Cresswell
Response:
On Sat, 12 May 2001 19:43:17 GMT, Steven Litvintchouk <sdlit…@earthlink.net
wrote:
The problem is, how to convince doctors that I’m really getting disabled. So far, my family physician has even refused to write me a note for my employer to give me additional sick time. She says that since she hasn’t seen me coughing much, she can’t tell how disabled I am.
Lawyers specializing in disability should be able to help, failing all else. – Hide quoted text — Show quoted text -
Unfortunately, especially with asthmatics, the worst coughing occurs at NIGHT, destroying my sleep, and my doctor never gets to see that. I even offered to take a camcorder and videotape myself coughing at night!
Response:
Don Brady wrote:
Also you might consider getting a large disability income policy just in case, while you have a large income. The underwriting questions may not spot the bronchitis as a potential cause of disability.
I already have a nice big long-term disability policy. The problem is, how to convince doctors that I’m really getting disabled. So far, my family physician has even refused to write me a note for my employer to give me additional sick time. She says that since she hasn’t seen me coughing much, she can’t tell how disabled I am. Unfortunately, especially with asthmatics, the worst coughing occurs at NIGHT, destroying my sleep, and my doctor never gets to see that. I even offered to take a camcorder and videotape myself coughing at night! — Steven D. Litvintchouk Email: sdlit…@earthlink.net "I guess I could have paid a little closer attention when I was in English class, but it all worked out OK. I’m gainfully employed." – President George W. Bush
Response:
Steven My quality of life is undoubtedly degraded, to a variable extent depending on how bad I am. I have three kids under ten, however, and not working is not an option for me. I’m lucky to have an understanding employer who’s more interested in whether I fulfill my job objectives than whether I’m in the office 9-5 every day. Even when my sinusitis/bronchitis is bad, I rarely get systemically ill (eg. fevers/muscle soreness, flu-type symptoms), so although I feel below-par for much of the time, I’m not disabled by my illness. More, it interferes with my personal life. I can’t get physically fit, I rarely feel like going out socially, I’ve had to give up choral singing. I would not be even contemplating frontal sinus obliteration if it weren’t for these quality-of-life factors. I guess it’s the same for many/most chronic sinusitis sufferers. SFL
Response:
Also you might consider getting a large disability income policy just in case, while you have a large income. The underwriting questions may not spot the bronchitis as a potential cause of disability.
Response:
Suffol wrote:
Steven My quality of life is undoubtedly degraded, to a variable extent depending on how bad I am. I have three kids under ten, however, and not working is not an option for me. I’m lucky to have an understanding employer who’s more interested in whether I fulfill my job objectives than whether I’m in the office 9-5 every day.
Yes, this is starting to sound familiar….
Even when my sinusitis/bronchitis is bad, I rarely get systemically ill (eg. fevers/muscle soreness, flu-type symptoms), so although I feel below-par for much of the time, I’m not disabled by my illness.
That’s the way I was, except I got this chronic cough. If I cannot stop the coughing, especially at night, I’m going to be in trouble. I’m seeing a pulmonologist this Tuesday.
More, it interferes with my personal life. I can’t get physically fit, I rarely feel like going out socially, I’ve had to give up choral singing. I would not be even contemplating frontal sinus obliteration if it weren’t for these quality-of-life factors.
Does your surgeon think that this "frontal sinus obliteration" has a chance of succeeding where your previous surgeries failed? Or is it just a desperate shot in the dark? — Steven D. Litvintchouk Email: sdlit…@earthlink.net "I guess I could have paid a little closer attention when I was in English class, but it all worked out OK. I’m gainfully employed." – President George W. Bush
Response:
On Thu, 10 May 2001 05:04:52 GMT, Steven Litvintchouk <sdlit…@earthlink.net
wrote:
The problem I’m having is, this mess is interfering with my ability to hold a full-time job. I’ve been out of work a number of times in the last 6 months. If the symptoms you report have not compromised the quality of your life, I truly envy you.
I do not know what your profession is, but you might do well as an independent consultant or some such, (like me), so that you have the potential to have more control over your environment (e.g work at home).
Response:
- Hide quoted text — Show quoted text -Suffol wrote:
Steve I too have this horrible synergy between sinusitis and bronchitis. With me, the way it goes is whenever I get a flare-up of my chronic sinusitis, I get a dose of bronchitis too. The phlegm I cough up is precisely the same colour as the stuff that comes down my nose (for me, normally a distinctive electric yellow. Yuk). Sometimes the bronchitis clears quickly with antibiotics, but sometimes I go on coughing stuff up for three weeks or more. The sinusitis never clears completely; the best I get is a week of reduced drainage and fewer frontal headaches, and then the cycle begins again. I’m never really ‘ill’ with this, but I’ve been low-grade sick for almost the whole of the last eight years. I do all of the right things, take everything the dr prescribes with religious observance, irrigate frequently, and yet I just don’t ever get completely better. I’ve had four sets of ESS and am now awaiting a second opinion on frontal obliteration. I read in a medical journal recently a description of some patients as ‘upper-respiratory tract cripples’, and that’s just what I feel like after eight awful years. So; no great advice, but you’re not alone either!
The problem I’m having is, this mess is interfering with my ability to hold a full-time job. I’ve been out of work a number of times in the last 6 months. If the symptoms you report have not compromised the quality of your life, I truly envy you. — Steven D. Litvintchouk Email: sdlit…@earthlink.net "I guess I could have paid a little closer attention when I was in English class, but it all worked out OK. I’m gainfully employed." – President George W. Bush
Response:
Bacterial infections in the lungs cause such mucus. Pneumonia for one type. I suggest a quick trip to the Dr. These types of actual infection can do great damage to your lungs, and do it fast. Boyd — ———————————————————————- "The cure for boredom is curiosity. There is no cure for curiosity."
Response:
On Wed, 09 May 2001 06:15:09 GMT, Steven Litvintchouk <sdlit…@earthlink.net
wrote: – Hide quoted text — Show quoted text -
Here I am, a couple of years after my sinus surgery. And I have this daily coughing up of yellow phlegm (though not a great deal). Either hot steam and/or Albuterol tend to loosen it up so I can cough it up. Nasal irrigation doesn’t show any yellow mucus in the nasal passages or sinuses. The phlegm "feels" like it’s coming from all the way down in my trachea; I can feel the mucus "buzzing" around down there. Which suggests that it’s not post nasal drip, but is yellow mucus being constantly secreted in my airways. Four weeks of Levaquin failed to fix it. Can chronic sinusitis cause a kind of chronic bronchitis? Or cough-variant asthma (which is what I was originally diagnosed with)? What does sinusitis due to your LOWER respiratory tract anyway? Thanx in advance for any help!
I find exercise clears my cough (and clears my sinuses). Have you tried exercise twice a day (say a one-half-hour walk). Also are you sure you have eliminated allergens from your environment? Have you tried a three week vacation somewhere else? I find my cough gets worse the more time I spend in a dusty office. Moreover, it takes weeks (and longer) to clear when I stay away from that office. In other words, it has a very long-term cycle. I suspect that more severe bronchitis, such as you have, might show similar patterns.
Response:
Steve I too have this horrible synergy between sinusitis and bronchitis. With me, the way it goes is whenever I get a flare-up of my chronic sinusitis, I get a dose of bronchitis too. The phlegm I cough up is precisely the same colour as the stuff that comes down my nose (for me, normally a distinctive electric yellow. Yuk). Sometimes the bronchitis clears quickly with antibiotics, but sometimes I go on coughing stuff up for three weeks or more. The sinusitis never clears completely; the best I get is a week of reduced drainage and fewer frontal headaches, and then the cycle begins again. I’m never really ‘ill’ with this, but I’ve been low-grade sick for almost the whole of the last eight years. I do all of the right things, take everything the dr prescribes with religious observance, irrigate frequently, and yet I just don’t ever get completely better. I’ve had four sets of ESS and am now awaiting a second opinion on frontal obliteration. I read in a medical journal recently a description of some patients as ‘upper-respiratory tract cripples’, and that’s just what I feel like after eight awful years. So; no great advice, but you’re not alone either! SFL
Response:
Here I am, a couple of years after my sinus surgery. And I have this daily coughing up of yellow phlegm (though not a great deal). Either hot steam and/or Albuterol tend to loosen it up so I can cough it up. Nasal irrigation doesn’t show any yellow mucus in the nasal passages or sinuses. The phlegm "feels" like it’s coming from all the way down in my trachea; I can feel the mucus "buzzing" around down there. Which suggests that it’s not post nasal drip, but is yellow mucus being constantly secreted in my airways. Four weeks of Levaquin failed to fix it. Can chronic sinusitis cause a kind of chronic bronchitis? Or cough-variant asthma (which is what I was originally diagnosed with)? What does sinusitis due to your LOWER respiratory tract anyway? Thanx in advance for any help! — Steven D. Litvintchouk Email: sdlit…@earthlink.net "I guess I could have paid a little closer attention when I was in English class, but it all worked out OK. I’m gainfully employed." – President George W. Bush
Response:
Categories: Cough Variant Asthma | 
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I agree with Ellis that the original poster may well be reacting to the propellant in the Flovent — the reaction described is typical when one is sensitive to the propellants/additives in MDIs. Many such people find that the Pulmicort Turbuhaler makes a tremendous difference and does not come with the ‘triggers an attack’ side effect. If one is in Canada, there is also Bricanyl [terbutaline; a short-acting bronchodilator] and another preventer med available in Turbuhaler form — as in other countries, except the USA. SW.