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Hello, I just wanted to update this question by letting you know that I'm not expecting the answer in 24 hrs or so.. plz take some time and get back to me, no rush. I need help answering all of my questions in depth and precisely plz..

thanks !


I'm seeking ENT medical board opinion please:

Hello Sir,


I’ve been suffering from sinus condition from many years (7 yrs plus). I had one sinus surgery done in Oct 2010. At that time, I was diagnosed with deviated nasal septum, had narrow passage on right nostril. Procedure performed: Bilateral Endoscopic Sinus Surgery with Septoplasty. my ENT cleaned mucus filled sinuses, widen the right side nostril passage. Within a year, I was having facial fain so I did another CT. I went to see another ENT, I was told that I’m having blockage in left frontal sinus (complete opacification) and that is because of the bone has grown and blocked the drainage – bone might have grown either during the healing process or because of scaring due to the surgery done in Oct 2010. Another opinion from other ENT suggested that bone can not grow there and it is not a bone. I’m confused !

Could you help answer all of my questions precisely and in depth please:

q.1 looking at the CT, do you believe that my blockage is caused by a bone? Is that a bone or just really hard mucus/ solidified mucus got built up over the time? If it is a bone then what should I do now? Can I leave / should I leave the blockage for the long time, I’m 35 yrs male. What are the long term effects? Can that spread any infection to eye or brain on a long run? I’ve attached word doc that contains CT images and Lab reports.

q.2 I’m having Constant mild or dull pain 24x7 on the bridge of the nose, surrounding both the eyes, mainly below both eyebrows, area of the nose that is between the eyes. See my picture attached, I’ve marked the areas of pain with arrows and circles. When symptoms are worse, pain/pressure goes mild to severe. I feel that dull pressure or pain on both the sides (not only left), my questions are: If I’m having only left frontal blocked what justifies my pain on right side too? why I feel dull pain on the areas I’ve shown in the picture? Why heaviness on centre of the nose or bridge of the nose? I know left maxillary is also little filled up with mucus per the latest scan Oct 2014, but still why I feel heaviness on the centre of the nose, surrounding right hand side eye, below right eyebrow too and bridge of the nose instead of just the left side of facial areas? Do my symptoms match with CT? FYI.. I also feel waking very tired every day in morning (even) when have 7 hrs of sleep Mon- Friday, work week.. when I raise the eyebrows up and down I can sense the heaviness.

q.3 what is the reason for fatigue? Why 7 hrs of sleep not enough for me and I feel tired, feel lack of ability to concentrate? Does my clinical condition based on CT supports this? Is my Blocked sinus responsible in anyway for fatigue - even indirectly?

q.4 my ENT has proposed this procedure to remove frontal blockage: Rev. F.e.s.s. + Mod. Endoscopic Lothrop + Landmarxs – to remove the bone, basically they suggest to drill the frontal sinuses bone, combine the drainage of right and left both the sinuses into one. My questions are: will that help resolve my facial pain areas shown in the picture? What could be the consequences of doing such surgery as ENT is suggesting removing large chunk of bone. I’m unsure what to do? What are the long term drawbacks that I should be aware of ? just because the fact that removing blockage is a good thing, will I be worse off in future by doing this / facing other problems unknown at this stage? what are the complaints and feedback - positive and negative both - of other patients who have had their frontal sinuses drilled? Is such type of surgery a common or a minor procedure, that I should not hesitate to consider doing that or are there serious consequences that I should be really mindful of?

q.5 I’m using sinus rinse kit from some time, what is the best way / best position to use it to allow the saline water to reach to the frontal sinuses or that can benefit specifically to my condition? Here is the YouTube link to give you some idea of the rinse kit with the pre-mix sachet that I’m using. they suggest to lean forward, tilt the head down in the sink and insert the tip but I think it only goes to the maxillary area, what about the frontal sinuses? For my specific condition for frontal blockage what is the right methodology to use rinse kit? I guess, because of the blockage, saline water is not going to clean up left frontal but still I want to know the best method that can give benefit for my condition.

q.6 Can I use rinse kit in this way or would it harm? Tilt the head completely upward, like watching towards the ceiling, insert the rinse bottle tip and pour the saline water into the each nostril one by one while holding the breath. While holding the breath, move head left and right side slowly, keep head in upward position for 3-5 sec, then tilt the head down, let the water out, whilst bending the head down, move head left and right to clear up the remaining water.

q.7 if I continue to use rinse kit, for let’s say 6 months daily, will it remove the blockage in frontal sinus? I haven’t used it daily basis for prolonged time as yet.

q.8 my latest CT is also showing some blockage in left maxillary, I’m using this rinse kit, will it remove the thickening with the periodical use over a long time, let’s say if I use daily for 3 months – will that all stuck mucus go away ? I guess that blockage in maxillary area is a sticky material like a paste.

Your help is very much appreciated..

Thank you !


Category: ENT Specialist

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Category: ENT Specialist
 22 Doctors Online

Thank you for posting your query at

I am really sorry for all the delay .
I can understand your problem and i will try my best to explain your doubts
You are suffering from “ Sinus” problem for 7 years and underwent surgery (septoplasty and FESS) in
2010. Now you are suffering fromcontinuous mild or dull pain on the bridge of nose and surrounding
area, some time it is severe.
I could see all ct pictures. 1st i want to tell about your CT – Your previous surgery is done alright ,
no deviation of septum. Your left frontal sinus is opaque, you have small retention cyst in left
maxillary sinus . so other then left frontal sinusitis your CT is almost normal, and frontal sinus
finding is also same for last 3-4 years, it is not spreading to any of surrounding area and it is not
causing and damage to surrounding bone and there is no thinning or expansion or erosion of left frontal
sinus bony wall. So i can tell will full confidence that your symptoms are not related to this left
sided fronal sinusitis as all other sinuses including right frontal and bilateral ethmoid sinuses are
normal and as seen in your picture you have tenderness and pressure symptoms in bilateral frontal and
ethmoid sinus area.
So will not advise for any revision surgery, there is no bony growth following surgery , it is a normal
bony wall of frontal sinuses and it is not blocked by bone but soft tissue is filling frontal sinus and
blocking it also. What surgery is advised to you is very morbid , it is associated with many
complication even in expert hands and same time it will not serve any purpose as you have bilateral
dull aching headace.
Now about possible cause of your symptoms (headache) mayinclude-
refractory error (power changes of eye)- can be ruled out by simple eye checkup
it can be stress related headache – very common in young people and it can cause dull aching pressure
type of headache, this explains tiredness, bodyache also, i think most probable diagnosis will be
stress related headache in your case- simple life style changes, counselling and simple medication for
some time may help in treating this once this is confirmed by treating physician.( you can start tab.
Amitriptiline 10 mg once in night for one month)
Leaving this blocked frontal sinus will not harm you in future , but still you are very much worried
about it a good endscopic surgeon can clear it with endoscopic sinus surgery only no need for all major
procedures,(my opinion is no surgery and just a regular follow up with simple xray PNS once in 2 years
adequate to see status, as we can see frontal sinus clearly in xray only and ct will cause lots of
radiation exposure.)
No need to rinse nose with any technique, but you can use nasal spray to treat sinsusitis – Mometasone
nasal spray one spray in each nostril two times daily of 3-6 months will help in clearing it also.
Hope this helps,

Patient replied :

Thank you for your reply. I’ve few questions though.
Q1. I’ve had my eye tested and I was told that I don’t need any prescription glasses. So that is normal and out of equation. When I’m out of work / or no work at all even for few weeks, even when my routine is normal, no stress at all, I still feel tenderness and some pressure on marked areas with circles and arrows in my facial picture that I’d copied in the word doc. By the way I don’t get headaches. What else you think could be the reason ? could my CT condition, specifically frontal blockage area, be not the reason at all for my facial pain on marked areas.
Q2. Have you come across other patients similar to my condition having frontal sinus blocked? What are their symptoms look like? Do they complaint different than what I’m talking about? I’m curious what else could be the reason for my facial tenderness and pressure areas.
Q3. How confident you are in saying that blockage is due to soft tissues and not be the hard bone?
Q4. Let’s say, if eye numbers, stress are not quite likely be the reason for my pain, what else you think could be the culprit? The other thing, I wanted to say is, I get post nasal drip, but that is not so severe. When I’ve 6 to 7 hrs of sleep, I still feel tenderness on face. Like other people, I can’t seem to concentrate well with 6 to 7 hrs of sleep. I know 8 hrs of sleep is min recommended, and even when I’d 8 hrs of sleep, next day, I still feel bit tendered but 6-7 hrs makes it bit worse just to give you an idea.


Your eye check up is normal, so that's fine.

You have pressure and tenderness not really headache and you are able to sleep for 6-7 hours.

Your left sided sinusitis can not explain pain on right side and pain below eye.

You should not give pressure around eya as there are superficial nerves in this area and pressure on same can cause tenderness.

Soft tissue is seen in frontal recess ( frontal sinus drainage area) in few ct cuts.

These pain or pressure symptoms are not very typical of any disease but these atypical and vague symptoms we see frequently.

You can get opinion of local neurologist also.

Hope this helps,

Beat regards

Dr. Sunil Jalan
Category: ENT Specialist
DAA (Diploma in asthma and allergy) : Christian Medical College, Vellore, 2012
D.N.B (ENT), 2011
Residency - M.S. (Master post graduate degree in otorhinolaryngology),  Christian Medical College, Vellore, 2009
D.L.O. (Diploma in otorhinolaryngology) - Christian Medical College, Vellore, 2007
Medical School - M.B.B.S, S.P. Medical college, Bikaner, 2004
Dr. Sunil Jalan and 4 other Medical Specialists are ready to help you

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