I get runny nose with small bony defect in ethmoid region. Do I need surgery?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hello doctor,

Frequently, I have had water coming from my nose for the past three months. CT scan result shows an S-shaped DNS more towards the right and left inferior turbinate hypertrophy. There is a small bony defect in the roof of the right ethmoid sinus region with adjacent mucosal thickening.

There is mild mucosal thickening in the left maxillary, right ethmoid, and frontal recess region. Do I need surgery? What could be the accuracy? Can I have side effects?

Please help.

Answered by Dr. Mohammed Osama Aboborda

Hello,

Welcome to icliniq.com.

I understand your concern.

Sure, you need surgery to correct DNS (deviated nasal septum) or to resect hypertrophied turbinate, and to close the bony defect. The operation has a high success rate, as it will be an endoscopic nasal operation.

There are some complications, such as bleeding, orbital fat herniation, orbital hematoma, and injury to the brain, as the defect is at the base of the skull. Do not panic. All these complications are rare when done by a well-trained surgeon. Please send your CT scan report.

I hope this helps you.

Thank you.

Patient's Query

Hello doctor,

I am attaching the reports.

Kindly advise.

Answered by Dr. Mohammed Osama Aboborda

Hello,

Welcome back to icliniq.com.

I understand your concern.

If you have normal breathing with no problems with inspiration and no snoring, then you can avoid surgical correction of your septum. Also, you can use an intranasal corticosteroid spray for hypertrophied turbinates. The surgery is optional for DNS and hypertrophied turbinates.

But the bony defect in the ethmoid roof must be corrected surgically; it is not optional. Until you undergo surgery, you have to know about the precautions. Avoid sneezing, coughing, straining, crying, and anxiety. Even if you have to sneeze obligatorily, you have to open your mouth while sneezing to make sure that the pressure comes out of the mouth.

I hope this helps you.

Thank you.

Patient's Query

Hello doctor,

I do not have a breathing or snoring problem. I am not sure whether I need surgery. Please suggest. Does the CT scan show a bony defect? I am not getting proper sleep due to a runny nose. Please recommend some medicine to avoid it.

Kindly advise.

Answered by Dr. Mohammed Osama Aboborda

Hello,

Welcome back to icliniq.com.

I understand your concern.

Please say whether you analyzed the secretion coming from the nose. If it is nasal mucosal secretion, the treatment is an intranasal corticosteroid. If the fluid is cerebrospinal fluid, it comes from a bony defect, and the only remedy is surgery to close the defect. I studied the scan carefully, and I can see the small bony defect.

I hope this helps you.

Thank you.

Patient's Query

Hello doctor,

I would like to know whether the surgery can solve my problem 100 %. Can I have side effects after surgery? How many days will it take to come back to normal?

Kindly advise.

Answered by Dr. Mohammed Osama Aboborda

Hello,

Welcome back to icliniq.com.

I understand your concern.

If the nasal discharge is cerebrospinal fluid, it indicates a bony defect, and surgery will completely resolve the problem. If the nasal discharge is mucus, dental and turbinate surgery can reduce symptoms. But it will not solve the problem completely. The side effects are profuse bleeding due to an injury of any main blood supply, orbital fat herniation, orbital hematoma and cerebrospinal fluid leak due to iatrogenic meningeal injury.

All these previous side effects are uncommon with a well-trained surgeon. You can leave the hospital in two days, and you need complete rest for a week at home under medical treatment. Go ahead with surgery to close the defect. Septal and turbinate surgery is not mandatory, especially as you do not have breathing problems.

I hope this helps you.

Thank you.

Patient's Query

Hello doctor,

What type of surgery is recommended to close the defect?

Kindly advise.

Answered by Dr. Mohammed Osama Aboborda

Hello,

Welcome back to icliniq.com.

I understand your concern.

You need functional endoscopic sinus surgery. This surgery is performed with the help of endoscopes. So there are no external incisions. Usually, the defect is closed by a fatty tissue or synthetic cement according to the size of the defect and the surgeon's choice.

I hope this helps you.

Thank you.

Patient's Query

Hello doctor,

How soon do we need to do this surgery? Can we take three to four weeks' time?

Kindly advise.

Answered by Dr. Mohammed Osama Aboborda

Hello,

Welcome back to icliniq.com.

I understand your concern.

Do it as quickly as possible. Today is better than tomorrow. Till the time of surgery, avoid straining, sneezing, coughing, and anxiety.

I hope this helps you.

Thank you.

Patient's Query

Hello doctor,

I think I have this problem due to a bike accident that happened before three months.

Kindly advise.

Answered by Dr. Mohammed Osama Aboborda

Hello,

Welcome back to icliniq.com.

Yes, it can be the main cause.

I hope this helps.

Thank you.

Patient's Query

Hello doctor,

Please let me know if anything else that I need to take care. I am going for surgery. Do I need any special checkups?

Kindly advise.

Answered by Dr. Mohammed Osama Aboborda

Hello,

Welcome back to icliniq.com.

I understand your concern.

You need to do liver and kidney function tests, a bleeding profile, an electrocardiogram, a complete blood picture, fasting, and postprandial blood sugar.

I hope this helps you.

Thank you.

Patient's Query

Hello doctor,

Surgery has been scheduled for tomorrow. Could you please review the attached latest results? She has Sinus and a 2 mm bone defect.

Kindly advise.

Answered by Dr. Mohammed Osama Aboborda

Hello,

Welcome back to icliniq.com.

I understand your concern.

The MRI shows the same defect with cerebrospinal fluid leak plus brain tissue herniation. It means there is a minimal piece of brain protruding through the bony defect.

I hope this helps you.

Thank you.

Patient's Query

Hello doctor,

She has Sinus and 105 sugar. Would that be a problem for surgery? Also, she was stressed due to work pressure and was tense.

Kindly advise.

Answered by Dr. Mohammed Osama Aboborda

Hello,

Welcome back to icliniq.com.

I understand your concern.

No problem. Best wishes to you all.

Thank you.

Patient's Query

Hello doctor,

Thank you, I will be in touch with you.

Kindly advise.

Answered by Dr. Mohammed Osama Aboborda

Hello,

Welcome back to icliniq.com.

I understand your concern.

I am waiting to hear from you.

I hope this helps you.

Thank you.

Patient's Query

Hello doctor,

Surgery has been done. However, she is still feeling pain, and fluid is coming. It is been one week since surgery was completed. The doctor gave the attached prescription. Not sure about the result of surgery. Please let me know if that is common.

Kindly advise

Answered by Dr. Mohammed Osama Aboborda

Hello,

Welcome back to icliniq.com.

I understand your concern.

Continue the treatment; it is excellent. Another MRI should be performed at least one month after surgery to evaluate the result of the surgery. The patient must avoid straining, sneezing, constipation, and coughing.

I hope this helps you.

Thank you.

Patient's Query

Hello doctor,

She developed a cough immediately after surgery because her nose was closed. Would that cause any issues? Is there any medication to avoid sneezing? She has a dust allergy, which causes frequent, uncontrollable sneezing. Please let me know if there is any additional advice on avoiding sneezing.

Kindly advise.