Re: ossification of sinuses

[Guest guest]

This is a repost from memory, it looks like my original message did not post.---------------Louis,

I

am sorry to hear that your sinuses are in such a bad shape.

You and have well

described calcification. Calcification may often arise as a result of severe

inflammation. Therefore, it is very important to try to address the cause(s) of

the inflammation in the first place in order to try to halt or slow the

process.

Inflammation, remodeling and

calcification are partly self-sustained processes, but they also have causes

that drive them. I do not mean that these causes are easy to find, nor

treatable, but I think it is imperative to try to identify them. They just don't

happen spontaneously.

Further frontal surgery, such

as a Draf3, is not guaranteed to solve the problem, unless the only pathology

is within the frontals' tissue, or stems from a basic local anatomical drainage

malfunction, which I doubt given your description, which sounds like the

problem is more widespread.

Draf3 sometimes work and

sometimes fail, and frontal sinus obliteration by filling them with fat may

also work or fail, because, in my opinion, these do little to address

underlying issues. This is understandable : if you have, say, osteitis,

just pulling out the mucosa and filling the space with fat will achieve

nothing. Scarred mucosa will still grow back, and nothing will prevent it from

getting inflammed again from the underlying bone infection. It might even be

worse because the fat filling would reduce accessibility.

Likewise, adressing all the

sinuses is important, because if your frontals are easily accessible, the other

sinuses may easily inflame them, even if they are filled with fat.

So, in such a case, surgery

would have to be thought of more as a helpful complement, rather than as the

solution itself.

This checklist of questions

may help :

How is your polyp status

right now, are they under control ?What is your current medication

regimen ? Are your medications reasonably dosed (not too high) ?

How is the rest of your

immunity ? Do you have other chronic conditions apart from Samter's ?

Has an endoscopic swab and

germ culture by a competent lab ruled out tissue infection ?

Has any of your surgeons had

the idea of performing a sinus bone biopsy to check for infection ?

Is your allergy status under

control ? Could there be any environmental triggers (including food, work,

etc) that may have escaped your scrutiny ?

>> Thankyou for your comments gypsymouse .I believe once the changes are chronic ie fibrotic or calcific change, surgery becomes the only option. I totally agree with asa desensitization,irrigation,leukotriene inibitors etc. being the maintenance program of choice pre and post surgically. I believe you know your sinus anatomy is altered beyond inflammatory changes when doses of prednisone make no difference.I know I am looking forward to a Draf 3 or modified lothrop procedure just to address some of the changes in my frontal sinuses,realizing that this doesn't begin to address the chronic remodelling that has occurred in the other sinuses.Thank you so much in letting me know I am not alone in this.I believe its surgery for me or suffering from the complications of AERD or the medical therapy or drugs I take to control it.The choice is simple surgery or the grave.Louis>