Vacuum Sinusitis

Vacuum sinusitis is a peculiar ailment in which a person seems to develop sinusitis symptoms without having an infection. We're not even 100 percent sure it exists, but we do know people sometimes have:

• symptoms of sinusitis, particularly facial pain, which temporarily get better when they take sinus medications

• a normal CT scan that shows no obstructions of sinus ostia

One possible explanation is that these patients actually have intermittent blockage—one day the doors are shut, the next they're open, and the next after that they're shut again. So a CT scan taken on a day when the ostia happen to be open will not show an obstruction.

In these patients, when the ostia shut, it's thought that the interior lining of the sinuses absorbs the oxygen in the sinuses. The resulting negative pressure forms a vacuum in the sinuses that causes pain.

Because vacuum sinusitis is not well understood, ENT doctors are generally reluctant to operate on patients who have normal CT scans. Instead, we usually try steroids and decongestants. In addition, we look for another diagnosis that may be causing sinusitis-like symptoms, such as migraines, neuritis, or neuralgia, as discussed in Chapter 20.

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