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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Tuesday, February 7, 2012
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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Tuesday, February 7, 2012
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Ear, Nose, and Throat Disorders |
Sequestered bone in sphenoid sinus06/22/2007 |
I had removal of fungal mass seated in sella turcica thought to have been seated there since transphenoidal hypophysectomy in 1982 in Nov. of 2006. This was done with my 6th sinus surgery--ultimately--all sinus cavities have more or less been `removed` interconnecting all sinus cavities in to one open area. I have had repeated (3 episodes since Dec. 2006 that have required steroids/antibiotics and nearly a month each to resolve) since the Nov. surgery and was told that a small area of bone remains unhealed/infected in sphenoid area (staph--not MRSA). I do have multiple allergies (including most antiboitics) and intrinsic + extrinsic asthma (usually well controlled). I am scheduled (after perplexion with ENT surgeon and my internal med PCP and conservative measures which have failed) to have this piece of bone removed. The ENT suspects adrenal insufficiency--although basic tests were in low normal range (but no cortisol challenge test was ever done) S/P hypophysectomy. When bone is removed from this sinus, in conjunction with culturing, are histologic tests also performed routinely (i.e. to R/O sarcoidosis)? I just wonder since the pulmonary component has become worsened and I do have granulomas on CXRs. Secondly, if this removal of bone does not `fix` the problem, should I seek opinion of pulmonologist and/or endocrinologist? Can adrenal insufficiency cause these `problems` (that seem similar in some ways to sarcoidosis)? The nasal cortisone sprays seem to trigger headaches with me (moreso than headaches that I already am experiencing from the sinus disease. Thank you so much for your response.
Clearly you have a very complicated problem with a very complicated history. From your description, it sounds as though a pulmonary and endocrinology evaluation are both indicated regardless. In fact, a 2nd ENT and neurosurgical opinion would be reasonable as well, considering the many infections and surgeries you have already experienced. Should you undergo another surgical procedure, then any tissue removed is indeed evaluated histologically.
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Allen M Seiden, MD Professor of Otolaryngology Department of Otolaryngology College of Medicine University of Cincinnati |
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