What could be causing my persistent salty post-nasal drip after sinus surgery?

Salty post-nasal drip post-surgery may result from complications like CSF leaks, intracranial pressure, or reflux affecting the sinuses.

How can a CSF leak be diagnosed if initial tests are negative?

Further specialized tests and examinations are needed if initial CSF leak tests are negative but symptoms persist.

What is the significance of evaluating gastroesophageal reflux in sinus-related symptoms?

Nasal pH monitoring helps diagnose reflux-induced sinus symptoms contributing to post-nasal drip and headaches.

What should be considered regarding medication in persistent sinus symptoms after surgery?

Reviewing current medications is important as they might worsen sinus symptoms or cause side effects.

Why might sinus problems be complex to treat after surgery?

Sinus issues post-surgery often have multiple causes requiring comprehensive evaluation for effective treatment.

Salty Post Nasal Drip with Headaches After Surgery

Question
For nearly 3 years I have been getting salty post nasal drip with headaches. I had a CT scan of my sinuses which showed only mild to moderate mucosal thickening. I had FESS bilateral unicectomies, middle meatal anthrostomies and anterior ethmoidectomies.

I wish I never had the surgery done, the salty drainage is so bad, I’m constantly coughing in tissues and have a constant high-pitched ringing in my ears. I have really bad anxiety and depression since the operation. I feel so ill everyday. I’m 22 year old female and it’s ruining my life.

I think I might have a csf leak. Had beta 2 transferrin test, which came back negative. I coughed the fluid from the back, I dont get any out the front of my nose. My recent CT scan doesn’t show any evidence of a leak. Been tested for allergies and am not allergic to anything.

What can I do? Thank you.

Answer

Thanks for your note.

It is really hard to let you know without a complete examination, and it sounds like you have been cared for appropriately without the results one would really hope for or expect.

I definitely would suggest further evaluation for csf leak or increased intracranial pressure.

Any medications you are taking need to be looked at. At the NY Sinus Center, we would also look whether there is Gastro esophageal reflux as high as your sinuses causing these symptoms, usually by Restek pH monitoring in the nasal cavities.

Unfortunately, very often sinus problems are complex, rather than straightforward, and treatment really requires understanding the cause of one’s problems.

Robert Pincus MD

Co-director NY Sinus Center

Let’s clear things up

Frequently Asked Questions

Persistent salty post-nasal drip after sinus surgery can be caused by complications such as cerebrospinal fluid (CSF) leaks or increased intracranial pressure. Even if initial tests like beta-2 transferrin come back negative, further evaluation might be necessary to rule out these causes. Other factors like gastroesophageal reflux reaching the sinuses may also contribute to symptoms.

If initial diagnostic tests such as beta-2 transferrin assay and CT scans show no evidence of a CSF leak, additional evaluations may be required. This could include more specialized imaging or clinical examinations to detect subtle leaks or increased intracranial pressure that might not be evident initially.

Gastroesophageal reflux can sometimes irritate the nasal cavities and contribute to sinus symptoms including post-nasal drip and headaches. Detecting reflux at the nasal level typically involves pH monitoring in the nasal cavities, which helps identify if acid reflux is causing or exacerbating sinus issues.

Medications can impact sinus symptoms either by side effects or through interactions affecting nasal mucosa and drainage. A thorough review of all medications you are taking is essential to determine if any could be causing or worsening your symptoms, and adjustments may be needed accordingly.

Sinus problems after surgery can be complex because multiple underlying causes such as anatomical changes, infections, reflux, or neurological issues like intracranial pressure may coexist. A careful and comprehensive evaluation is necessary to understand the cause and to tailor effective treatment strategies.

Salty Post Nasal Drip with Headaches After Surgery

Frequently Asked Questions

Dr Robert Pincus