“The practice of medicine is a thinker’s art, the practice of surgery a plumber’s.” ~ Martin H. Fisher
In my last post, I briefly mentioned some of the complications that may be associated with transsphenoidal surgery (see here for more information). Although not serious, one of the more common concerns involves a sinus infection, which may cause a number of bothersome symptoms such as: facial pressure (in the eyes, nose and cheek area), stuffy nose, headache, fatigue, brain fog and thick nasal discharge. Transsphenoidal means “through the sphenoid sinus” (one of the facial air spaces behind the nose), and so the neurosurgeon essentially inserts his surgical instruments (such as a microscope, endoscope, nasal speculum, and so on) through the nose and sphenoid bone, in order to access and remove the pituitary tumor. This procedure may lead to inflammation of the sinuses, which can ultimately block the nasal passage and inhibit the normal drainage of bacteria. These bacteria multiply and therefore frequently result in a sinus infection.
Treating my sinus infection
Prior to my transsphenoidal surgery this year, I was suitably advised of the risk of sinus infection and told that in such an event I should visit my general practitioner in order to get a prescription for antibiotics. In most cases, where the blockage is caused solely by post-op inflammation, this may be a sufficient means of relieving sinus congestion. I informed my neurosurgeon of the fact that I had already undergone three previous sinus surgeries (the last one only being carried out at the end of 2009) and he assured me that this would not pose any problems. So, when I discovered I had a sinus infection, I readily went to see my GP and completed ten days of Amoxicillin antibiotics, along with almost three boxes of over-the-counter Mucinex (it was only after I’d finished ingesting the second box that I discovered my GP had been remiss in establishing that Mucinex-*D* was the correct form). Unfortunately, I observed no noticeable changes in my symptoms and a follow-up appointment with my neurosurgeon reassured me that due to post-operative inflammation, it would likely take several months for the infection to clear up. My surgeon also recommended sinus rinses (such as the neti pot), and I ardently commenced with the NeilMed sinus rinses on a twice a day basis. For more than a month, I optimistically continued with the rinses, and although some improvement was shown, it seemed minimal.
If you have previously undergone sinus surgery, it may be worthwhile consulting your ENT doctor BEFORE undergoing transsphenoidal surgery.
The ENT doctor
A fellow patient’s wife (and now friend) thoughtfully recommended an Ear, Nose and Throat (ENT) doctor who had experience in cleaning out the material from the sinus cavities following pituitary surgery. I eagerly made an appointment with him and underwent a CT scan, before regrettably discovering that all my previous sinus surgeries had been completely destroyed by my relatively recent transsphenoidal surgery. I was astounded. It seems that as my neurosurgeon entered my sinus cavity, he inadvertently crushed my septum and rearranged the superior turbinates via his speculum. Nasal turbinates are bony prominences that structure the inside of the nose. My neurosurgeon had pushed them outwards, so that they ended up plugging up my sinuses. My ENT doctor therefore explained that I would need a fourth sinus surgery in order to reconstruct all the damage and alleviate my symptoms. Unfortunately, in my case it is likely that I shall need to undergo another transsphenoidal surgery at some point in the future (post-operative blood work suggests there is another microscopic tumor or residual tumor)…. Which will ultimately lead to yet ANOTHER sinus surgery. For now, therefore, my doctor recommended Prednisone steroids and 6 weeks of AMOX-CLAV. I am hoping that I will soon establish when my next pituitary surgery will likely be, so that I can make a suitable decision about when to undergo my next sinus surgery. Hopefully, both my ENT doctor and neurosurgeon can work together in taking care of both the brain and sinus issues associated with my next transsphenoidal surgery. I believe that such a situation should have indeed arisen with my last transsphenoidal surgery, and I am perturbed that my surgeon did not take extra measures to ensure that the structure of my nose facilitated normal function after undergoing such a rigorous procedure.
This post is not intended to criticize my neurosurgeon. After all, his priorities are to remove the pituitary tumor safely and effectively, without causing any serious long-term damage. He is an excellent surgeon, and I am sufficiently confident in his work and hope that he will carry out my next transsphenoidal surgery. A family member used a clever analogy in order to describe his efforts: “He saved the house from burning in the fire, but broke down the front door in the process!”
Sinus Infection Information from emedicinehealth