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On Mucous, Steroids and Antibiotics

Dear Doc:

A Sinus CT Scan reveals up to 60% mucous retention/blockage in my frontal sinuses and the Sphenoid sinus which impacts my nasal resonance so I want to reverse this condition and avoid surgery.

As the Sphenoid is hard to reach with a conventional nasal rinse I was recommended a technique whereby you tilt your head back, to let hypertonic saline gravitate into the deeper reaches of the sinuses, hold it in, then bend forward to let the solution drain out.

While I invariably get the liquid in both ear canals each time, I’m now doing this along with Flonase and Guaifenesin daily. (I’ve also heard of ‘enhancing’ the saline by mixing antibiotics and corticosteriods into the solution).

Can this actually work to break down impacted mucus in the Sphenoid sinus, or can you recommend any other ideas to try?

Thanks! Mike.

Dear Mike,

My first question on reading your query, is, are you having any clinical symptoms from the x-ray findings that you describe? Most people with mucus retention in the sphenoid have no symptoms and the same is true for the frontal sinus. Obviously, if you’re having pain or pressure over your forehead or the top or back of your head then the condition is symptomatic and should be treated.

The technique you’re describing is a very old one called Proetz displacement. It is unlikely to work and there’s no reason to add antibiotics since you don’t have infection. Similarly, Steroids are unlikely to open up the sinuses.

I also wonder whether this truly affects your nasal resonance, since the sensation of resonance in the mask comes primarily from the nose, and not from the sinuses.

If based on the above you do have significant symptoms, I would have surgery to drain the sinuses. This does not need to be a major procedure, but I would see someone with significant clinical experience in the area.

Dr Jahn