TESTING – CT Imaging the Sinuses (Sinus CT Scan)

Everyone who has ever had ANY medical test deserves to have at least some understanding of what the test is for and how the results are used. That holds true for sinus x-rays and CT scans. Be sure to read my article on Development of the Sinuses, and also this one about What to Expect When Taking Your Child for Their Sinus CT Scan. Here is a short course in “reading” CT scans of your child’s sinuses.

How To “Read” A Sinus CT Scan

CT Imaging of the Sinuses

Today I will focus on imaging the sinuses. Computed Tomography (CT) Scans.

(I will cover imaging of the neck, and imaging of the ears – along with imaging of the temporal bones, separately at another time).

Important consideration: All test results must be interpreted along with the medical history. A CT scan alone does not determine whether a patient has acute sinusitis, chronic sinusitis, or whether they may need surgery. The whole patient must be considered when reviewing the test results.

How to “Read” a CT Scan: Orientation

The beauty of CT scans is that they can be artificially “rotated” inside the computer. This gives docs the ability to change the angle of the “slices” through the head – the “plane”.

In practical terms, there are only 2 planes that are common for imaging the sinuses: the coronal plane, and the axial plane:

Images of Coronal and Axial Planes

 

Drawing of Coronal Plane for Sinus Imaging

Drawing of Coronal Plane for Sinus Imaging

Above is a drawing of the CORONAL PLANE.

Our view is from the front (ARROW).

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Drawing of Axial Plane for Sinus CT Imaging

Drawing of Axial Plane for Sinus CT Imaging

Above is a drawing of the AXIAL PLANE.

Our view will be looking up at the slice (ARROW).

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First, some ground rules for “reading” Sinus CT Scans

  • white stuff is bone (or teeth)
  • black stuff is air
  • gray stuff is something else – cheek, brain, eyeball, snot, blood – something else, can’t tell what

Let’s take a look at a few Sinus CT Scans From Patients

 

Here is a reminder of where the sinuses are:

Image of Face with Sinuses

 

pediatric sinusitis pediatric allergies allergic rhinitis children toddlers infants

Sinuses in the Facial Skeleton: Maxillary (M), Ethmoid (E), Frontal

On the drawing above, E denotes Ethmoid Sinuses, and M denotes Maxillary Sinuses.

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CT Scan of Sinuses in the Coronal Plane

 

CT Scan of Pediatric Sinuses Coronal Plane

CT Scan of Pediatric Sinuses, Coronal Plane

 

The drawing on the left shows us about where the slice was taken for the CT Scan Image on the right. It goes through the mid or front part of the eye sockets (orbits), ethmoid sinuses, and maxillary sinuses. Compare the CT scan on the right with the drawing of the sinuses and the child’s face just above.

Let’s “Read” The Coronal Sinus CT Scan Above

On the right, the patient is facing us, their right side is on our left and vice versa. Look toward the right side (the patient’s left sinuses): all of the sinuses are black – full of air. That’s a good thing. Now look over at the left side (the patient’s right sinuses): there is some gray stuff in the Maxillary Sinus. Can’t tell exactly what that is, but we can speculate, based on years of experience. Some of it is probably secretions – snot. Some of it is probably swelling. That swelling that goes all the way around the sinus suggests chronic inflammation – chronic sinusitis.

CT Scan of the Sinuses in the Axial Plane

CT Scan of Sinuses in Axial Plane

CT Scan of Sinuses in Axial Plane

Let’s “Read” The Axial Sinus CT Scan Above

The drawing at the left shows the level of the slice, below the eye sockets, through the level of the maxillary sinuses. The CT Scan on the right shows the maxillary sinuses full of black – air (arrows). These are relatively healthy sinuses. We are looking up at the slice, so the patient’s right is on our left of the image, and vice versa.

CT Scan of the Sinuses in the Axial Plane


Let’s “Read” The Axial Sinus CT Scan Above

The drawing at the left shows the level of the slice, through the middle of the eye sockets, higher up than the previous scan. The CT Scan on the right shows the ethmoid sinuses, full of black – air (arrows). Again, these are relatively healthy sinuses.

CT Scan of Sinuses in the Coronal Plane

 

Pediatric Sinusitis CT Scanning

Pediatric Sinusitis – CT Scan, Coronal Plane

Let’s “Read” The Coronal Sinus CT Scan Above

The drawing on the left shows the level of the coronal slice, through the back part of the eye socket. The corresponding CT Scan image on the right shows the ethmoid sinuses, and the maxillary sinuses, nearly full of gray stuff.

In this case, these are nasal and sinus polyps. Only the patient’s right maxillary sinus (on the left of the CT scan) shows a small area of air (black).

This is severe, advanced polyp disease. This can be seen in children with Cystic Fibrosis.

Summary

That should provide the basics to help understand your little boogorhead’s Sinus CT scans. At least, when your ENT doc discusses the findings you can keep up now. For the curious, check out some of the previous articles on this blog about Sinus CT scans, listed below in Resources. Please leave a reply or email me with questions or comments! Thanks for visiting!

More imaging later: I will cover imaging of the neck, and imaging of the ears (and temporal bones) separately at another time.

Over the coming months there will be experts from various areas of medicine here to review the how-and-why of testing. Stay tuned.

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Resources From This Blog:

  1. Role of the Beattles in the Invention of the CT Scanner: http://www.whittington.nhs.uk/default.asp?c=2804&t=1
  2. 8 Dangerous Complications of Sinusitis, 3 That Can Kill: http://wp.me/pR4iB-57
  3. Nasal and Sinus Anatomy, Histology, & Physiology: http://wp.me/pR4iB-1g
  4. 3-Year-Old Boy Hospitalized for Severe Chronic Sinusitis: http://wp.me/pR4iB-2k

______________________________________________________________________

 

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Best of health and success to you and your families.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor :~D)

Comments

  1. excellent post on reading images of a sinus CT scan. looking forward to more of your posts on imaging.

    I’m curious though, why is the sagittal plane not really used when looking at sinus CT scans?

    • Russell A. Faust, PhD, MD says:

      Hi Wisdom,
      To answer your question: the sagittal orientation simply does not provide an optimal view of the most important areas of sinus drainage – the “osteo-meatal complex”, whereas the axial and coronal planes provide this and more.
      Thanks for visiting. RF

  2. Eve Heshler says:

    Thank you for your article. My son recently had a CT scan of his sinuses after being diagnosed with chronic sinusitis. He previously had been diagnosed with moderate sleep apnea. He has been continuously sick with sinus infections, eye infections, etc. We are waiting to meet with the ENT tomorrow and I was curious to see what he may say. I can see that his maxillary sinuses are completely gray. Hopefully this will help clarify why he has been so sick and help with a resolution.

    • Russell A. Faust, PhD, MD says:

      Hi Eve,
      Best success! Let us know how it goes.
      RF

      • Eve Heshler says:

        Update: The CT scan showed the sinuses had cleared. Unfortunately he had been on antibiotics for a few days before we could get an appointment. He was ok for about a month before he started having recurrent strep infections. He ended up with 2 visits to the ER and a diagnosis of PANDAS before having his tonsils and adenoids removed. We are now dealing with some depression and neurological tics as a result. It’s been a long road.

        • Russell A. Faust, PhD, MD says:

          Eve,
          So sorry to hear about your son’s PANDAS. No idea why, but I had a group of patients (all children, of course) with PANDAS when I was faculty at the University of Virginia. Some of them had great relief from tonsillectomy/adenoidectomy.
          The good news about the clear CT scan is that his sinuses cleared while on antibiotics. That tells me that the issue with his sinuses is not anatomic. That is, the openings are clear. He either has “mucosal disease” (allergic swelling or other chronic inflammatory changes), or perhaps biofilm. Biofilm bacterial infections typically “clear” while on antibiotics, but return full force within a couple weeks after completing the course of antibiotics. Take a look at this site for articles on ridding him of “biofilm”.
          Please let us know how things go for your boy.
          RF

  3. Eve Heshler says:

    I actually did follow your advice on biofilm. We did nasal rinses regularly for awhile and the sinus infections stopped for awhile. Unfortunately the strep started. Is it possible to have strep in your sinuses? After the last bout of strep was over, he got another sinus infection. He was also diagnosed with blepharitis, which I was wondering if that could also be related to strep. Anyway, he is healing well from the T&A and we’re hoping the tics he has disappear after he returns to his former healthy self. They seem to have started as a result of the discomfort from strep as well a the constant post nasal drip.

    • Russell A. Faust, PhD, MD says:

      Eve,
      Nasal saline rinses ARE the treatment for biofilm, but eradication of the biofilm requires adding things to the saline. Manuka honey is the most effective, and also easiest when dealing with children – nice to make the rinses sweet-tasting. The other thing to consider is adding a couple drops of baby shampoo. Research has shown that baby shampoo (or other detergents, but baby shampoo is the mildest) can help break up the biofilm. A word of caution: ONLY a couple drops! More than that burns! Speaking from personal experience :))
      Best success with your son! Please do keep us updated on his progress.
      RF

  4. Eve Heshler says:

    How long after a T&A can we resume nasal rinses, specifically those with baby shampoo?

    • Russell A. Faust, PhD, MD says:

      Hi Eve,
      You COULD begin them immediately. But if you are including the baby shampoo to the rinse (remember to be cautious with how much you add – only a couple drops!) to help eliminate chronic biofilm, I would wait one week after T&A. Just to minimize the misery. After all, even a little of that shampoo in the rinse may burn a bit, and life is miserable enough after a T&A.
      Let me know how things go.
      RF

  5. Eve Heshler says:

    Just got back from the doctor and my son has another sinus infection just a few weeks after the last. We will definitely be adding the baby shampoo to the nasal rinses to try to rid him of that biofilm.

    • Russell A. Faust, PhD, MD says:

      Eve,
      That’s frustrating!!

      A word of warning: Go EASY with the baby shampoo! Just a couple drops per rinse bottle. I have made the mistake of putting ounces in at a time – wow, that burned!!!

      Also: if you have not done so already, consider adding a daily probiotic to his regimen – the Probiotic Pearls for Children, by Ingtegrative Therapeutics, is BY FAR the best on the market, and the one that I give to my own little boogorheads. I take their Probiotic Pearls for adults, the Advantage one, I think. (transparency: I have no financial arrangements with Integrative Therapeutics. I buy mine on Amazon, like everyone else).

      Wishing you success, and do keep me updated!
      RF

      • 2 days off of antibiotics and my son is complaining of of the same symptoms already. We are doing the nasal rinses and probiotics, as well as Nasonex. Is there anything I should request from my ENT ? This doesn’t seem normal to me.

        • Russell A. Faust, PhD, MD says:

          I’m sorry to hear that, Eve.
          Depending on your son’s age, and depending on what his symptoms are, it may be that his symptoms are not necessarily from his sinuses. My best advice is to find a worthy physician that you trust, and work with them to figure things out.
          Please keep us updated on what is going on.
          Best success,
          RF

          • Just an update…the pediatrician referred us to an immunologist after finding low IGg in bloodwork. It turns out my son has very low pneumococcal titers which can cause sinusitis. He gave him a booster shot and in 3-4 wks he will recheck his titers.

          • Russell A. Faust, PhD, MD says:

            Hi Eve,
            Yes, those subtle immune anomalies can cause chronic troubles. And for the chronic troubles where we aren’t able to find the immune anomalies, I suspect that we are merely looking in the wrong place, or can’t yet detect the anomaly.
            Thanks for the update, and for sharing this. I hope that parents with children struggling with chronic inflammatory issues ask their pediatricians about possible subtle immune deficiencies.
            RF

          • Eve Heshler says:

            Hi Dr. Faust,
            I am back with another update…after years of struggling with sinus infections, tics and anxiety so bad that my son could barely go to school, it was discovered that he had an h. pylori infection. He was treated with 2 doses of antibiotics, as well as an acid reducer. After treatment, his anxiety went away and he went almost an entire school year without any absences. He is doing very well. I am now trying to spread awareness about how some infections can cause anxiety and other psychological problems in children. I believe this infection wreaked havoc on his body so badly that it kept him from getting a proper diagnosis. It affected his stomach, as well as his sinuses, brain, and even his kidneys and bladder. It was only when his sister started exhibiting classic symptoms that the infection was discovered in my son.

          • Russell A. Faust, PhD, MD says:

            Eve,
            Thank you for the follow up!!
            Yes, as we learn more about our “microbiome” – the collection of microorganisms growing on us and in us – we are learning that they determine our health. From things like obesity to diabetes risk to sinusitis. Pretty amazing.
            Thanks again for sharing!

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  9. Hi – Is a CT the best definitive way of diagnosing sinusitis? I’ve had head-congestion, balance problems, headaches, blocked/runny nose for years, and it’s debilitating and restricting. It’s mainly on my LHS. My GP still isn’t convinced, and refuses to refer me to an ENT specialist!
    I’m at my wits end because I see my condition gets gradually worse.
    Any advice would be appreciated.

    • Russell A. Faust, PhD, MD says:

      Sinus CT Scan is the “gold standard” for imaging sinus infection or other sinus disease. Until recently, a plain-film (“x-ray”) set of three x-rays were the standard, but now a limited Sinus CT is about the same cost as the sinus-series of x-rays, and is so much more sensitive that nobody in the US uses the plain x-rays any more.

  10. SCWilliams says:

    Dr., I am 63 and have had sinus issues all of my life. I have once again been experiencing problems, dizzyness, head pressures, left ear pressue, nausea, etc. I have been on every sinus antibiotic including a recent round of specially formulated, Cap Tobra 160/ITRA50/FLUTIC3 mg. My CT scan shows Clear but that could not be possible. I know have a left ear aches and have headaches and symptoms are worse. Any ideas?

    • Russell A. Faust, PhD, MD says:

      The ear and head “pressure” sensations and dizziness are more likely to result from ear issues – eustachian-tube dysfunction or vestibular neuritis, as examples – than to result from sinus issues. This could be why your CT scan seems clear. It might be time for a thorough ear and hearing eval.

  11. SCWilliams says:

    Meant to say thank you for any assistance.

  12. Mohammad Ali says:

    Hi Dr,
    Thanks for sharing a good peice of knowledge with us about CT scan. Dr I had a CT scan of paranasal sinus which showed maxillary sinus with polyps and deviated septum. My ENT has recommended for a surgery but I still can’t understand why I have left ear blockage, pressure and little dizziness. My ENT says it is due to sinus but I am not sure. Could you please help me?

    • Russell A. Faust, PhD, MD says:

      I can’t think of why your maxillary sinuses would affect your ear or cause dizziness either. My recommendation – and this is my advice when anyone is recommending surgery – is for another opinion. That is, consider visiting another ENT to ask your question.

      Thanks for sharing. Best success, and please let me know how it goes.

  13. Hello Dr , im so happy that I came across this site . I was trying desperate to find answers on the CT scan of paranasal sinus .
    This is what it said on my report : volumetrically acquired scans were taken through the paranasal sinuses and reviews in the coronal plane .
    There is minimal mucosal thickening or fluid in the floor of the right maxillary sinus .
    Incidental note is made of a concha bullosa of the middle turbinate on each side .

    My concern is this , how do I read it or where do I take this scan for additional info as my Dr told me everythig is perfect . They scanned the entire brain , and entire face and there is no nerve injury or anything major .
    But Im still suffering with severe right eye pain ear and right side of the face.
    Can this scan cover entire brain and entire face as he told me .
    Please any explanation is greatly appreciated .
    Thank you so much .

    • Russell A. Faust, PhD, MD says:

      Hi Diana,

      There are many ‘cranial nerves’ in the face and head, some of which can insidiously cause pain. The trigeminal nerve is just one example, causing “trigeminal neuralgia.” Some ENT docs are familiar with this (most are not, or at least not well-trained on managing it); some neurologists are familiar with this. It will be up to you to do the research and find a clinician with expertise in managing facial pain, migraine headaches, etc. And here is the link to my article on how to “read” a ct scan: http://www.boogordoctor.com/testing-ct-imaging-the-sinuses-pediatric-ent/

      Thank you for taking time to share, and best success!

  14. I am having a sinus ct (no contrast) done in a few days. My question is, are both angles standard? As in will the sinus ct be taken from the top angle as well as the front facing angle or is it one or the other?

    • Russell A. Faust, PhD, MD says:

      Hi Kate:

      The beauty of CT Scans is that they are constructed from digital data. That means that the radiologist can “reconstruct” virtually any view from the original CT scan. So when I pull up a CT Scan of one of my patients on the monitor at the hospital, I can look at Axial views, Sagittal view, or Coronal views – all without needing to re-scan the patient. That minimizes the amount of radiation required for useful images.

      Best success!

  15. I recently saw an ENT. He did this thing up my nose and said I had multiple deviations. I have suffered with sinus issues as long as I can remember. He ordered a CT. What is that like? I should have asked but it just dawned on me as my appt. is next week….is it just ex-rays? Nothing painful?

  16. Does the coronal sinus CT cut though the frontal lobe of the brain?

  17. Barbara soucy says:

    Hi. I have had a sinus infection for three months. Three antibiotics and every otc treatment there is with no relief. Worse symptoms is post nasal drip with thick secretions hard to swallow. Headaches over eyes. Dr found deviated septum but cat scan showed clear sinuses! Where is mucus coming from then??? I’m confused and need help! He’s testing for allergies soon but no allergy med working.

    • Russell A. Faust, PhD, MD says:

      Hi Barbara:
      Couple things to note:
      (1) Even if your sinuses are “clear” by CT scan, you can still have rhinitis or sinusitis (or rhino-sinusitis): inflammation of the lining of the nose or sinuses.
      (2) The lining of your nose and sinuses produces a quart of mucus – snot – every day. Normally. And normally you are not aware of that, since it is thin, not viscous, and it drains down your throat, to be swallowed.

      The secretions produced do some great things to keep us from becoming infected by various microorganisms that try to enter your body through your nose: the secretions contain a special immunoglobulin that binds to microorganisms and keeps them from adhering to the lining; the amount of secretions we produce also helps, simply by the hydro-mechanic action of washing microorganisms away. These are swallowed along with the secretions, and killed by stomach acid.

      The problem arises when something causes irritation of the lining. Irritation results in (1) increased amount of secretions (body’s attempt to wash away the irritant), which would not be noticeable except for the second thing that happens (2) increased viscosity of secretions. It is that increase viscosity that makes us aware of the post-nasal drainage.

      Things that can irritate the lining include:
      -things you are allergic to (“allergens”)
      -environmental irritants – cigarette smoke, smog, diesel exhaust, etc
      -irritants in our homes – chemicals in our clothing, wall coverings, upholstery, etc
      -any upper respiratory infections – virus, bacteria, fungus (mold), etc
      -food sensitivities – not true “allergies,” but still potentially cause allergy-like symptoms

      Even if your allergy tests come back as “negative,” you may still be sensitive to things in your environment, or things that are in your diet. Best solution: to find a physician who specializes in such things, to help you get to cause of your chronic inflammation. My personal solution was to find a Doctor of Naturopathy, with a more holistic, big-picture approach. She helped me (finally) put an end to my own chronic rhino-sinusitis.

      Thank you for visiting, reading, and sharing!
      Best success.

  18. Jennifer says:

    Hi i have been suffering with sinus issues for over a year now and had a paranasal CT scan recently. My results showed extensive mucosal thickening involving ethmoid, maxillary and frontal sinuses. Debris/fluid within right sinus with min aeration. Releative sparing sphenoid sinus. Suspecious of permeative bony destruction. What does this mean?

    • Russell A. Faust, PhD, MD says:

      Hi Jennifer:

      The clinician that ordered your CT scan is the person to answer ALL of you questions at this point. [And glad to hear that your sphenoid sinus is spared.]

      Best success.

  19. Hi
    My Son has been suffering from chronic sinusitis from about 4 months of age. He is now 4 and we are very frustrated that there is not an answer to his issues. We have done tonsils and adenoids with a small amount of relief but still on antibiotics every month for sinusitis of strep with no symptoms ( maybe from nose drainage?). His tonsils have started to grow back. Could his adenoids have grown back? This Biofilm you reference in other posts…what is the best method (s) to try to remove? My son also had a CT done 2 years ago that showed hypoplasia of the frontal sinus. Is this something he will outgrown? Is it worth another CT at age 4 to see if this is still a contributor or if something else anatomically is wrong?
    Thanks in advance for any feedback.

    • Russell A. Faust, PhD, MD says:

      Hi Marsha:

      It is very unusual for tonsils to grow back after being completely removed. Due to the fact that adenoids are not truly encapsulated, and are more like a cluster of grapes that are impossible to completely remove during adenoidectomy, adenoid re-growth is not rare. For children with chronic rhinitis / sinusitis, especially after removing the adenoids and tonsils as the potential reservoir of pathogenic bacteria or other microorganisms, in my experience many of those children have chronic reflux – GERD. Regular, nightly reflux of stomach enzymes up into the nasopharynx causes chronic inflammation of the back of the nasal passages and adenoid area. In my patients who experienced re-growth of their adenoids following surgery, most of them had reflux. Studies have been carried out, looking at the fluid in sinuses of such children: gastric enzymes were found in the sinuses! Only one way for those enzymes to get there – reflux. There are pediatric ENT docs who insist that reflux is actually the number-one cause of sinusitis in children.

      Does you son wake up at night? Does he have a chronic cough? Does a cough every wake him up? Has he been diagnosed with asthma?
      Thanks for visiting and sharing. Please keep me updated.

  20. April Morgan says:

    My daughter has had a sinus infection and has been treated for it with 2 types of antibiodics. They have not helped. the inside of her one nostril is swollen and switches to the other occasionally. The Doc ordered a CT scan yesterday and I called for the results. They said that they have to have a Nourologist look at the CT before they can give me results. What does this mean? Is it normal for a Nourologist to review a sinus CT?

    • Russell A. Faust, PhD, MD says:

      April:

      What is your daughter’s age?
      Please keep me updated on the CT results and the Neurologist’s assessment.

  21. Shelly Gutierrez says:

    Hi Dr. quick question I have been sick with a cold for two weeks but noticed I started feeling dizzy and like the room was spinning and it’s been going on for about a week and a half now my dr ordered a ct scan of the head and my results came back I have chronic sinusitis, she referred me to an ENT which I have an appt for on Monday but my question is how likely am I to need surgery if I have never really suffered from sinusitis? Just want to be prepared for Monday?

  22. HHello I had balloon sinuplasty surgery 4 months ago. I have had chronic sinusitis for over 20 years and decided to have this surgery after researching it and found out how successful it is. I had a CT Scan (AXIAL) no contrast. The results were: clear paranasal sinuses and nasal cavity. No imaging findings of rhinosinusitis. Unchanged chronic right lamina papyracea fracture. Findings compatible with partially empty sella, which is commonly incidental and asymptomatic. Does this mean I no longer have sinusitis? Please clarify. Thank

    • Russell A. Faust, PhD, MD says:

      Hi Kathie:
      Wonderful news. Keep in mind: treat you – the patient – treat your symptoms and how you feel; do not treat a CT scan.

      Also keep in mind that a CT scan is merely a snap-shot in time. If a CT scan shows thickening of sinus lining today, the sinuses may have been perfectly clear last week, and may be perfectly clear next week: they only show conditions at the time of the CT scan.

      But in my experience, a perfectly clear CT scan following balloon sinuplasty is a wonderful result – a result that I would be proud of as the surgeon. Congratulations!

  23. hi, hoping you can help clarify something for me please?……
    when a radiologist reports on a sinus ct scan and they refer to the ‘right ‘ sinus, do they mean MY personal interpretation of right, OR ‘right’ as if they were standing in front of me looking at my face?

    • Russell A. Faust, PhD, MD says:

      Great question: when a radiologist says “right side,” they mean YOUR right side, which appears on the LEFT side of the CT scan (or whatever image you’re dealing with) when looking at it.

  24. my ct scan shows something that looks to me like a bug in my right maxillary sinus. I tried to copy and paste a picture of it in this message but it would not let me. I am wondering what it could possibly be. how can i post a picture of it for you to see?

  25. Hello, Dr.! I recently had a ct scan of my sinuses. The report shows mucosal disease in the right frontal sinus overflow tract, in the ethmoid sinuses, along the posterolateral wall of the right sphenoid sinus and in both left and right maxillary sinuses. My ENT did not put me on any antibiotic and I was wondering how these infected areas are going to get better? The report also states that my carotid canals are covered by bone. Is this something that I should be concerned about?

    • Russell A. Faust, PhD, MD says:

      Hi Constance:

      First, questions like these should be directed to your ENT or other doc(s) who ordered your tests, including your CT Scan. Second, “mucosal thickening” does not necessarily mean that you have an infection. For example, it can be suggesting of allergic inflammation, or inflammation from environmental irritants (tobacco smoke or others). Local thickening (“posterolateral wall…”) can simply be a focal collection of secretions – some thick mucus ‘glop’ can appear as soft tissue on a CR Scan.

      Please contact your docs for follow up on the specific of your tests and scans. It would be negligent for me to provide advice or specific comments on scans that I have not reviewed.

      Thanks for sharing, and best success!

  26. Hi Doctor
    I’m worried because I have had 5 CT scans of my sinuses in the past prior to having FESS surgery in 2014. I am worried about the amount of radiation that these scans have exposed me to. What do you think?

    • Russell A. Faust, PhD, MD says:

      Anne:
      The risk of imaging-related radiation is age-dependent, among other factors. The person to ask about your own exposure is your doc who ordered your imaging studies.

  27. is sinus dangerous if yes then what will be the result if its not cured ?

    • Russell A. Faust, PhD, MD says:

      Hi Joseph:
      Everyone has “sinus,” or sinuses. If your paranasal sinuses become infected, that can lead to serious illness, even – in rare cases – death or blindness. If you struggle with sinusitis, you should see a physician.

  28. sudhakar Nayakude says:

    Sir.. .My in CT scan report
    Impression – 1- Maxillary sinusitis
    2- Soft tissue density lesion (HU40 to 65) at floor of left maxillary sinus as described above s/o small polyp.. ..
    Plz sir tell me. ..surgery I required or not

    • Russell A. Faust, PhD, MD says:

      Sudhakar:
      Of course, without examining you AND reviewing your CT scans AND obtaining a thorough medical history, there is simply no way for me to form an opinion, much less give advice. If your physician/surgeon cannot provide the answer, time for another opinion (THAT is my advice).

  29. My question is, how can you tell from the scan above that there are nasal and sinus polyps and advanced polyp disease? Can you actually see the polyps on this scan, or is this an assumption based on the colors in the scan? I’m trying to interpret my own scan, and this would be helpful to know. Thanks!

    • Russell A. Faust, PhD, MD says:

      Great question, Anne!

      The truth is, it’s not possible to say that the soft tissue seen within the paranasal sinuses on CT Scan is polyps for certain. But usually, when the soft tissue appears “lumpy” (yes, very technical term :)), and especially if the soft tissue does not “layer-out” like liquid (with gravity, down at the bottom of the sinus), then the changes of the soft tissue being polyp is greater. But I have been fooled more than once.

      For example, in the image here labeled “Pediatric Sinusitis – CT Scan, Coronal Plane,” the maxillary sinus on the patient’s right (to the left of the image as we look at it), the air bubble (black) is at the bottom of the sinus, and the soft tissue (gray) is at the top. That seems like polyp tissue, and that was what I found during surgery. This child has Cystic fibrosis, infamous for causing polypoid disease in the sinuses.

      Hope that helps. Thanks for visiting, and for sharing your question. Best success!

  30. Hello. Could you tell me why you would do a CT of the sinuses lying face down with your chin up and not change positions? I had one in the past, but lied on my back. I just want to make sure it was down properly. I have went to the doctor repeatedly for forehead, face, and eye swelling, but I am starting to think there is something else more going on bc I also have swelling in my hands, feet, and calf. I had gotten a Depo Medrol shot after antibiotics, but instead of reducing the swelling it made it much worse. I also have had my kidneys checked so if it isn’t sinus then what else could it be at this point. I am a woman and will be 30 in two weeks. Thank you

    • Russell A. Faust, PhD, MD says:

      Hi Tiffany:
      The positioning is part of the protocol for the sinus CT Scan. Every institution uses their own protocol, but the position that you describe is designed to help any fluid that may be in the sinuses to “layer-out,” making it easier to see signs of infection. Regarding your specific treatment(s), of course I’m not able to provide any meaningful medical advice over the internet. You must ask your physician(s).
      Thank you for sharing, and best success!

  31. Hi, Dr. Faust,
    Thanks for your blog. In Nov. 2016 I was treated for acute sinusitis (both ethmoid and both maxillary sinuses were infected) with compounded saline rinse comprised of Mupirocin and Levofloxacin added to 8 oz. distilled water and NeilMed saline packet and 2 drops of baby shampoo. I did for 30 days and repeat CT showed infection had cleared. Antibiotic saline rinse discontinued but saline rinses continued. While infected, I noticed a gradual worsening of a constant foul odor coming from nose–everything smelled and tasted with this same foul smell. This persisted and sinus cultures taken and grew Klebsiella pneumoniae. Antibiotic sinus rinses re-initiated but changed to Gentamicin and Mupirocin. Current CT shows sinuses clear but foul sense of smell is worse than ever. Purulent drainage, productive cough, post-nasal drip, sinus congestion, general malaise, low-grade fever. If sinus CT is clear why would I have persistently have a foul odor distorting all smells and tastes? Can an infection be in the nasal area only and not show up on CT scan?
    It’s not a metallic taste. It smells like a bacteria (like something rotten). I stopped all sinus rinses and no improvement with smell/taste issue so I know it’s not coming from that.
    I have an underlying condition of myasthenia gravis so was worked up recently for a secondary immune deficiency. Negative but pneumococcus titer was too low.
    I appreciate any thoughts about the foul senses of smell/taste.
    Thank you!

    • Russell A. Faust, PhD, MD says:

      Hi Beth:
      What you describe, called “dys-osmia,” is not uncommon following a severe bacterial or viral nasal or sinus infection. Dysosmia usually resolves with time, but it may not. I do understand that it can be horrible and distracting, not to mention that it ruins any enjoyment of food.
      Please check back with your ENT doc for options. I have seen patients with dysosmia following sinusitis be treated with steroids, but your MG diagnosis must be considered. As always…ask your physician.
      Thanks for sharing your experience – there are others out there who think that they are the only ones experiencing dysosmia. And best success!

  32. Hi Dr. Fuast,
    I’m a 29 YO female w/ chronic tonsillitis, chronic sinusitis X 5 years not better with antibiotics. I gave up on trying to get treated but now it feels like I have something stuck between my nose and mouth all the time. Like a heaviness. I keep having to try and “pull” the stuff coming down by snorting and its starting to cause a lot of stress and discomfort. I went to an ENT and he scoped my nose and saw my turbinates were very enlarged on the right side. He’s recommending CT sinus, Tonsillectomy, turbinate reduction, possible sinus surgery (balloon, maybe) all done at once.

    My question is: Are each of the surgeries necessary? My tonsils are large but fairly asymptomatic aside from halitosis due to tonsil stones and enlarged lymph node in mid/superior jugular. The recovery time for tonsilectomy is long. I know there is an infection in there somewhere but what I don’t understand is how they are all connected. Are my turbinates causing my sinusitis and tonsilitis and will I feel relief by simply reducing those? My question is “which came first” in nature.
    Thank you in advance,
    Kelsey

    • Russell A. Faust, PhD, MD says:

      Hi Kelsey,
      Your story is familiar, but your questions can’t be answered without face-to-face evaluation. My best advice is to find an ENT doc who will spend the time to understand what is going on, but also spend the time to inform you about what is going on. The word “doctor” comes from the Latin word for “teacher.” If a doctor is not teaching you while they are healing you, they aren’t doing their job well.
      Sorry I’m not more help, but thank you for visiting and for sharing.

  33. pazhanivel says:

    i am a m.phil for yoga so nice the sinus reading point one thinking my mind whats the measure of sinus growth muscle or bone normal and abnormal
    kindly reply me

  34. Derek ward says:

    Is it absolutely necessary for a CT scan of the nasal cavity before polyp surgery?

    • Russell A. Faust, PhD, MD says:

      Many rhinologists and sinus surgeons refuse to operate on nasal polyps without a CT scan, for your own safety: polyps can erode bone over time, resulting in openings into the cranial cavity (brain) and orbit (eye). That means, without a CT scan to guide them, a surgeon can easily injure your eye or brain while removing polyps…not a good outcome either way. So if your surgeon is advising a CT scan, good idea. Best success

  35. Can you explain the process of having a clear Sinus CT and what that means? If it is clear does that mean you do not have a sinus infection? Even if you are congested, have post nasal drip all the time, losing you voice from it at times, headaches and facial pain and pressure? Do all sinus infections show on a CT scan?

    • Russell A. Faust, PhD, MD says:

      Hi Heather:
      The symptoms that most people ascribe to their sinuses can also result from allergies, and from migraine headaches. Allergies typically cause nasal stuffiness, changes in voice, and post-nasal drip; and allergies can be associated with headaches, facial pain. Migraine headaches are a more common cause of “Sinus” headaches – see this article.
      The real confusion results when nasal swelling from allergies trigger migraine headaches. In those cases, a clear sinus CT scan helps make that difficult diagnosis. A clear sinus ct scan does mean that, at least at the time of the ct scan, there is no sinus infection.
      The best way to get to the bottom of your symptoms is to find an allergist or ent doc who takes a more holistic approach – looks at the big picture – than simply focusing on their little corner of the world.
      Best success

  36. If a CT scan shows mild mucosal polypoid thickening on one side and you are symptomatic and have not taken antibiotics can you still have a sinus infection present? Is it 100% that you don’t have an infection if CT shows only minimal results yet symptoms are long-lasting and suggestive of sinus infection?

    • Russell A. Faust, PhD, MD says:

      Heather:
      It depends … on what the symptoms are. On exactly what the CT findings are. On the medical history. On the exam findings. Sorry to be so UNHELPFUL, but it is frustrating to be unable to diagnose people over the internet. My advice: find a doctor whom you trust and work with them to figure things out.
      Best success

  37. Hi, it’s been 6 months now that I have a nostril blockage ( left or right) according to my head position when I sit or lay down. My ENT Dr. has no clue about what could cause that (no allergy, no infection) and no treatment helps. I recently had a CT scan that only reveals a mucosal thickening of one of my right posterior ethmoid cell, could a such “simple” thing be the cause of my problem?
    Thanks J from France.

    • Russell A. Faust, PhD, MD says:

      Hi Vjay,
      The only suggestion I can offer is what I tell anyone who does not obtain satisfaction from their doctor: find another doctor and get another opinion. And another one if necessary.
      Best success

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