Sinusitis FAQ

Why won't my ENT doc?

Question:

there is a discussion on TMJ, prevention and treatment at http://www.ent-consult.com Murray Grossan, M.D. http://www.ent-consult.com

Response:

I agree with Heather….a good infection specialist may be a good idea. I’m pleased to hear the oral surgeon is sending you to someone who can help you with both situations….he sounds like he will be very thorough. I’m praying he’ll have some answers for you and will help you. Please let us know how your appointment goes tomorrow. SuzyQ   "Mike & Heather Collins" <mikeheath…@oakwellmount.freeserve.co.uk> wrote in message news:888h84$2ci$1@news6.svr.pol.co.uk…   Sherry,   I am so sorry to hear that you are so poorly still. With not hearing from you I wrongly assumed that that your infection was clear.   Did you ever see an Infectious Disease Specialist to get a firm diagnosis on the  possibility of a Mucor infection.  In my limited experience I thought the antifungal that he gave you was not the usual treatment given for a mucor infection and if I remember correctly Dr. Tichenor also expressed some doubts. I think Suzy will agree with me here. You have been treated very badly,please please go and see a good Infectious Disease Specialist.   Heather Collins   UK   Mikecheath…@oakwellmount.freeserve.co.uk     <se…@prodigy.net> wrote in message news:38A77908.F64C2CA8@prodigy.net…     Thanks for your reply SuzyQ.  I didn’t mean to stump anyone with my post, I was just asking a question.  My situation is very complicated.  I will try to explain:     1.  I have a total joint prosthesis  in my right TMJ (almost 4 years now with NO problems whatsoever).     2.  I have been put on antibiotics pre-dental appointments, surgeries, etc. because of the possibility of infection in the joint with the prosthesis.     3.  On October 28, 1999 (3 1/2 months ago), I had sinus surgery.  My ENT doc did a Caldwell-Luc on the right maxillary sinus to remove a screw (placed 7 years ago when I had jaw surgery). This screw was causing my sinuses to be inflamed and infected all the time and the only way he could get it out was to do a Caldwell-Luc procedure (where they cut inside your mouth from the front to the back above the teeth).  My ENT doc also did endoscopic surgery on both ethmoids, maxillaries and frontal sinuses.  My oral surgeon told me to make sure that my ENT doc gave me plenty of antibiotics to cover my prosthesis and I told my ENT doc a couple times (before the surgery) that he needed to be sure and give me plenty of antibiotics before, during and after the surgery.  Well, I remember him giving me antibiotics pre-op, but I don’t remember getting any antibiotics while I was in the hospital overnight (through the IV). He did give me a prescription for Cefzil when I was discharged from the hospital and I took it as soon as I could get it filled.  I had a lot of bleeding post-op (the day of and day after the surgery) and I was a little anemic for several days.     4.  About 2 weeks after the surgery (and after the packing was removed), my right TMJ started swelling up and throbbing with pain.  It got real red, felt feverish, and got a rash over the joint.  I told my ENT doctor, when I saw him for my 2 weeks post-op visit about my swollen joint and he just "brushed it off", like it wasn’t his problem.     5.  I waited another week, hoping my TMJ would calm down and it only got worse, so I ended up calling my oral surgeon (who put the implant in) and telling him what was going on. He wanted to see me immediately and was very concerned that I had gotten an infection in the joint from the sinus surgery.  He immediately put me on high doses of antibiotics for two weeks and wanted to see me again after I finished the antibiotics.     6.  I returned to my oral surgeon two weeks later with my joint swollen and red, more than ever.  The antibiotic didn’t touch it.  He then sent me for a CT scan (with and without contrast) of my whole head.  The CT scan was not easy for the radiologist to read because of all the artifact from the TMJ implant.  It was mostly a "splattered mess".  They could see that the implant was intact and was not cracked or broken.  They could also see a large amount of thickening over the right TMJ compared to the left but they couldn’t varify that it was infection.  They (the radiologist) also said that my sinuses were still "a mess", especially the right maxillary sinus which was very diseased.  I took my CT scan films to my oral surgeon (he wanted to see them) and he said he couldn’t believe that my right maxillary sinus was in such poor shape and that he could certainly see how it is possible that my right TMJ problems stemmed from the sinus surgery (in some way).     7.  Presently, my right TMJ is still swollen, throbs with pain, is inflamed, red and has a rash over the joint.  My oral surgeon did blood work a couple of weeks ago and they came back negative.  I was borderline on the WBC count at 10 and so he put me back on antibiotics for another 7 days.     8.  This Tuesday, I have an appointment (for a second opinion) with another doctor (an ENT "friend of my oral surgeon").  According to my oral surgeon, this ENT doctor (friend of his), will check my TMJ (surprise), plus my sinuses, salivary glands, neck glands, etc. and will make a decision on whether my problem is with the TMJ or with something else.     9.  My oral surgeon made the comment that it will probably end up being an infection in the joint that is not showing up on blood test or on the CT scan and that he will more than likely have to order a new prosthesis, remove the old prosthesis, clean out the joint and put in the new "all-metal" prosthesis. We’re talking major major surgery here and I really dread itl.     10.  I am just a little upset because my ENT doctor wouldn’t acknowledge my TMJ prosthesis when I told him it was swollen and hurting me.  I am also upset that he didn’t give me more antibiotics during and after the sinus surgery.  I haven’t had any problems with my sinuses since he did the sinus surgery but I have had continuous problems with my TMJ and I feel that he is partially to blame.     Sorry for such a long reply, hope you understand my dilema and why I ask why ENT docs won’t have anything to do with TMJ’s because the sinuses and TMJ are only inches away from each other and they can certainly cause problems for each other (I am a perfect example).     Hope you understand what I’m trying to say.  Thanks again for replying to my post.     Sherry     PookyBob wrote:       Please don’t feel that way….actually your post stumped me and I’m sure many others. It would go to make sense possibly because some folks complain about their necks hurting. TMJ is a very shakey subject when it comes to doctors…I know, because I used to have it really bad….the dentist would send me to a regular doc, then the regular doc would send me to an oral surgeon. Nobody wants to claim it….I think because the insurance laws are very strict on it. one option: make sure that your joint and bones are not involved in the infection…possibly via bone scan. Has the ENT told you where your infection is by CT Scan?       second option: buy one of those mouth guards that you boil and form. Use it while you sleep…this helped me tremendously….make sure you lower jaw is not in an overbite position when you mold it.       Let us know,       SuzyQ  "seudy" <se…@prodigy.net> wrote in message news:887dn4$4rbo$1@newssvr04-int.news.prodigy.com…>       > Well, looks like I’m getting the same kind of response from the ENT docs on       > here,       > that I get from my own ENT doc, which is "no response".     Thanks!         >       >       > <se…@prodigy.net> wrote in message news:38A3A396.2F579F37@prodigy.net…       > >       > > Why won’t my ENT doc have anything to do with my TMJ?  It is part of my       > > face and head.  It is between my nose and my ears.  It just happens to       > > be a "joint", is that the reason?  This makes no sense to me.  I will       > > get a swollen TMJ along with my sinusitis (chronic) and my ENT will only       > > take care of my sinuses.  He will not have anything to do with my TMJ.       > > Is there some law that says ENT doctors are not allowed to treat TMJ       > > pain and swelling?  Why do they always refer you to a dentist (oral       > > surgeon)?  The TMJ is a "joint"(just smaller than the other joints in       > > your body) and is NOT in my mouth or connected to my teeth in any way,       > > (so why a dentist)?  Okay, ENT docs, fess up!       > >       >       >

Response:

Sherry, I am so sorry to hear that you are so poorly still. With not hearing from you I wrongly assumed that that your infection was clear. Did you ever see an Infectious Disease Specialist to get a firm diagnosis on the  possibility of a Mucor infection.  In my limited experience I thought the antifungal that he gave you was not the usual treatment given for a mucor infection and if I remember correctly Dr. Tichenor also expressed some doubts. I think Suzy will agree with me here. You have been treated very badly,please please go and see a good Infectious Disease Specialist. Heather Collins UK Mikecheath…@oakwellmount.freeserve.co.uk   <se…@prodigy.net> wrote in message news:38A77908.F64C2CA8@prodigy.net…

  Thanks for your reply SuzyQ.  I didn’t mean to stump anyone with my post, I was just asking a question.  My situation is very complicated.  I will try to explain:   1.  I have a total joint prosthesis  in my right TMJ (almost 4 years now with NO problems whatsoever).   2.  I have been put on antibiotics pre-dental appointments, surgeries, etc. because of the possibility of infection in the joint with the prosthesis.   3.  On October 28, 1999 (3 1/2 months ago), I had sinus surgery.  My ENT doc did a Caldwell-Luc on the right maxillary sinus to remove a screw (placed 7 years ago when I had jaw surgery). This screw was causing my sinuses to be inflamed and infected all the time and the only way he could get it out was to do a Caldwell-Luc procedure (where they cut inside your mouth from the front to the back above the teeth).  My ENT doc also did endoscopic surgery on both ethmoids, maxillaries and frontal sinuses.  My oral surgeon told me to make sure that my ENT doc gave me plenty of antibiotics to cover my prosthesis and I told my ENT doc a couple times (before the surgery) that he needed to be sure and give me plenty of antibiotics before, during and after the surgery.  Well, I remember him giving me antibiotics pre-op, but I don’t remember getting any antibiotics while I was in the hospital overnight (through the IV). He did give me a prescription for Cefzil when I was discharged from the hospital and I took it as soon as I could get it filled.  I had a lot of bleeding post-op (the day of and day after the surgery) and I was a little anemic for several days.   4.  About 2 weeks after the surgery (and after the packing was removed), my right TMJ started swelling up and throbbing with pain.  It got real red, felt feverish, and got a rash over the joint.  I told my ENT doctor, when I saw him for my 2 weeks post-op visit about my swollen joint and he just "brushed it off", like it wasn’t his problem.   5.  I waited another week, hoping my TMJ would calm down and it only got worse, so I ended up calling my oral surgeon (who put the implant in) and telling him what was going on. He wanted to see me immediately and was very concerned that I had gotten an infection in the joint from the sinus surgery.  He immediately put me on high doses of antibiotics for two weeks and wanted to see me again after I finished the antibiotics.   6.  I returned to my oral surgeon two weeks later with my joint swollen and red, more than ever.  The antibiotic didn’t touch it.  He then sent me for a CT scan (with and without contrast) of my whole head.  The CT scan was not easy for the radiologist to read because of all the artifact from the TMJ implant.  It was mostly a "splattered mess".  They could see that the implant was intact and was not cracked or broken.  They could also see a large amount of thickening over the right TMJ compared to the left but they couldn’t varify that it was infection.  They (the radiologist) also said that my sinuses were still "a mess", especially the right maxillary sinus which was very diseased.  I took my CT scan films to my oral surgeon (he wanted to see them) and he said he couldn’t believe that my right maxillary sinus was in such poor shape and that he could certainly see how it is possible that my right TMJ problems stemmed from the sinus surgery (in some way).   7.  Presently, my right TMJ is still swollen, throbs with pain, is inflamed, red and has a rash over the joint.  My oral surgeon did blood work a couple of weeks ago and they came back negative.  I was borderline on the WBC count at 10 and so he put me back on antibiotics for another 7 days.   8.  This Tuesday, I have an appointment (for a second opinion) with another doctor (an ENT "friend of my oral surgeon").  According to my oral surgeon, this ENT doctor (friend of his), will check my TMJ (surprise), plus my sinuses, salivary glands, neck glands, etc. and will make a decision on whether my problem is with the TMJ or with something else.   9.  My oral surgeon made the comment that it will probably end up being an infection in the joint that is not showing up on blood test or on the CT scan and that he will more than likely have to order a new prosthesis, remove the old prosthesis, clean out the joint and put in the new "all-metal" prosthesis. We’re talking major major surgery here and I really dread itl.   10.  I am just a little upset because my ENT doctor wouldn’t acknowledge my TMJ prosthesis when I told him it was swollen and hurting me.  I am also upset that he didn’t give me more antibiotics during and after the sinus surgery.  I haven’t had any problems with my sinuses since he did the sinus surgery but I have had continuous problems with my TMJ and I feel that he is partially to blame.   Sorry for such a long reply, hope you understand my dilema and why I ask why ENT docs won’t have anything to do with TMJ’s because the sinuses and TMJ are only inches away from each other and they can certainly cause problems for each other (I am a perfect example).   Hope you understand what I’m trying to say.  Thanks again for replying to my post.   Sherry   PookyBob wrote:

    Please don’t feel that way….actually your post stumped me and I’m sure many others. It would go to make sense possibly because some folks complain about their necks hurting. TMJ is a very shakey subject when it comes to doctors…I know, because I used to have it really bad….the dentist would send me to a regular doc, then the regular doc would send me to an oral surgeon. Nobody wants to claim it….I think because the insurance laws are very strict on it. one option: make sure that your joint and bones are not involved in the infection…possibly via bone scan. Has the ENT told you where your infection is by CT Scan?     second option: buy one of those mouth guards that you boil and form. Use it while you sleep…this helped me tremendously….make sure you lower jaw is not in an overbite position when you mold it.     Let us know,     SuzyQ  "seudy" <se…@prodigy.net> wrote in message news:887dn4$4rbo$1@newssvr04-int.news.prodigy.com…>     > Well, looks like I’m getting the same kind of response from the ENT docs on     > here,     > that I get from my own ENT doc, which is "no response".     Thanks!       >     >     > <se…@prodigy.net> wrote in message news:38A3A396.2F579F37@prodigy.net…     > >     > > Why won’t my ENT doc have anything to do with my TMJ?  It is part of my     > > face and head.  It is between my nose and my ears.  It just happens to     > > be a "joint", is that the reason?  This makes no sense to me.  I will     > > get a swollen TMJ along with my sinusitis (chronic) and my ENT will only     > > take care of my sinuses.  He will not have anything to do with my TMJ.     > > Is there some law that says ENT doctors are not allowed to treat TMJ     > > pain and swelling?  Why do they always refer you to a dentist (oral     > > surgeon)?  The TMJ is a "joint"(just smaller than the other joints in     > > your body) and is NOT in my mouth or connected to my teeth in any way,     > > (so why a dentist)?  Okay, ENT docs, fess up!     > >     >     >

Response:

Thanks for your reply SuzyQ.  I didn’t mean to stump anyone with my post, I was just asking a question.  My situation is very complicated. I will try to explain: 1.  I have a total joint prosthesis  in my right TMJ (almost 4 years now with NO problems whatsoever). 2.  I have been put on antibiotics pre-dental appointments, surgeries, etc. because of the possibility of infection in the joint with the prosthesis. 3.  On October 28, 1999 (3 1/2 months ago), I had sinus surgery.  My ENT doc did a Caldwell-Luc on the right maxillary sinus to remove a screw (placed 7 years ago when I had jaw surgery). This screw was causing my sinuses to be inflamed and infected all the time and the only way he could get it out was to do a Caldwell-Luc procedure (where they cut inside your mouth from the front to the back above the teeth).  My ENT doc also did endoscopic surgery on both ethmoids, maxillaries and frontal sinuses.  My oral surgeon told me to make sure that my ENT doc gave me plenty of antibiotics to cover my prosthesis and I told my ENT doc a couple times (before the surgery) that he needed to be sure and give me plenty of antibiotics before, during and after the surgery. Well, I remember him giving me antibiotics pre-op, but I don’t remember getting any antibiotics while I was in the hospital overnight (through the IV). He did give me a prescription for Cefzil when I was discharged from the hospital and I took it as soon as I could get it filled.  I had a lot of bleeding post-op (the day of and day after the surgery) and I was a little anemic for several days. 4.  About 2 weeks after the surgery (and after the packing was removed), my right TMJ started swelling up and throbbing with pain.  It got real red, felt feverish, and got a rash over the joint.  I told my ENT doctor, when I saw him for my 2 weeks post-op visit about my swollen joint and he just "brushed it off", like it wasn’t his problem. 5.  I waited another week, hoping my TMJ would calm down and it only got worse, so I ended up calling my oral surgeon (who put the implant in) and telling him what was going on. He wanted to see me immediately and was very concerned that I had gotten an infection in the joint from the sinus surgery.  He immediately put me on high doses of antibiotics for two weeks and wanted to see me again after I finished the antibiotics. 6.  I returned to my oral surgeon two weeks later with my joint swollen and red, more than ever.  The antibiotic didn’t touch it.  He then sent me for a CT scan (with and without contrast) of my whole head.  The CT scan was not easy for the radiologist to read because of all the artifact from the TMJ implant.  It was mostly a "splattered mess".  They could see that the implant was intact and was not cracked or broken. They could also see a large amount of thickening over the right TMJ compared to the left but they couldn’t varify that it was infection. They (the radiologist) also said that my sinuses were still "a mess", especially the right maxillary sinus which was very diseased.  I took my CT scan films to my oral surgeon (he wanted to see them) and he said he couldn’t believe that my right maxillary sinus was in such poor shape and that he could certainly see how it is possible that my right TMJ problems stemmed from the sinus surgery (in some way). 7.  Presently, my right TMJ is still swollen, throbs with pain, is inflamed, red and has a rash over the joint.  My oral surgeon did blood work a couple of weeks ago and they came back negative.  I was borderline on the WBC count at 10 and so he put me back on antibiotics for another 7 days. 8.  This Tuesday, I have an appointment (for a second opinion) with another doctor (an ENT "friend of my oral surgeon").  According to my oral surgeon, this ENT doctor (friend of his), will check my TMJ (surprise), plus my sinuses, salivary glands, neck glands, etc. and will make a decision on whether my problem is with the TMJ or with something else. 9.  My oral surgeon made the comment that it will probably end up being an infection in the joint that is not showing up on blood test or on the CT scan and that he will more than likely have to order a new prosthesis, remove the old prosthesis, clean out the joint and put in the new "all-metal" prosthesis. We’re talking major major surgery here and I really dread itl. 10.  I am just a little upset because my ENT doctor wouldn’t acknowledge my TMJ prosthesis when I told him it was swollen and hurting me.  I am also upset that he didn’t give me more antibiotics during and after the sinus surgery.  I haven’t had any problems with my sinuses since he did the sinus surgery but I have had continuous problems with my TMJ and I feel that he is partially to blame. Sorry for such a long reply, hope you understand my dilema and why I ask why ENT docs won’t have anything to do with TMJ’s because the sinuses and TMJ are only inches away from each other and they can certainly cause problems for each other (I am a perfect example). Hope you understand what I’m trying to say.  Thanks again for replying to my post. Sherry – Hide quoted text — Show quoted text -PookyBob wrote: > Please don’t feel that way….actually your post stumped me and I’m > sure many others. It would go to make sense possibly because some > folks complain about their necks hurting. TMJ is a very shakey subject > when it comes to doctors…I know, because I used to have it really > bad….the dentist would send me to a regular doc, then the regular > doc would send me to an oral surgeon. Nobody wants to claim it….I > think because the insurance laws are very strict on it. one option: > make sure that your joint and bones are not involved in the > infection…possibly via bone scan. Has the ENT told you where your > infection is by CT Scan? > second option: buy one of those mouth guards that you boil and form. > Use it while you sleep…this helped me tremendously….make sure you > lower jaw is not in an overbite position when you mold it. > Let us know, > SuzyQ  "seudy" <se…@prodigy.net> wrote in message > news:887dn4$4rbo$1@newssvr04-int.news.prodigy.com…> > > Well, looks like I’m getting the same kind of response from the ENT > docs on > > here, > > that I get from my own ENT doc, which is "no response". > Thanks!   > > <se…@prodigy.net> wrote in message > news:38A3A396.2F579F37@prodigy.net… > > > Why won’t my ENT doc have anything to do with my TMJ?  It is part > of my > > > face and head.  It is between my nose and my ears.  It just > happens to > > > be a "joint", is that the reason?  This makes no sense to me.  I > will > > > get a swollen TMJ along with my sinusitis (chronic) and my ENT > will only > > > take care of my sinuses.  He will not have anything to do with my > TMJ. > > > Is there some law that says ENT doctors are not allowed to treat > TMJ > > > pain and swelling?  Why do they always refer you to a dentist > (oral > > > surgeon)?  The TMJ is a "joint"(just smaller than the other joints > in > > > your body) and is NOT in my mouth or connected to my teeth in any > way, > > > (so why a dentist)?  Okay, ENT docs, fess up!

Response:

Please don’t feel that way….actually your post stumped me and I’m sure many others. It would go to make sense possibly because some folks complain about their necks hurting. TMJ is a very shakey subject when it comes to doctors…I know, because I used to have it really bad….the dentist would send me to a regular doc, then the regular doc would send me to an oral surgeon. Nobody wants to claim it….I think because the insurance laws are very strict on it. one option: make sure that your joint and bones are not involved in the infection…possibly via bone scan. Has the ENT told you where your infection is by CT Scan? second option: buy one of those mouth guards that you boil and form. Use it while you sleep…this helped me tremendously….make sure you lower jaw is not in an overbite position when you mold it. Let us know, SuzyQ – Hide quoted text — Show quoted text -"seudy" <se…@prodigy.net> wrote in message news:887dn4$4rbo$1@newssvr04-int.news.prodigy.com… > Well, looks like I’m getting the same kind of response from the ENT docs on > here, > that I get from my own ENT doc, which is "no response".     Thanks!   > <se…@prodigy.net> wrote in message news:38A3A396.2F579F37@prodigy.net… > > Why won’t my ENT doc have anything to do with my TMJ?  It is part of my > > face and head.  It is between my nose and my ears.  It just happens to > > be a "joint", is that the reason?  This makes no sense to me.  I will > > get a swollen TMJ along with my sinusitis (chronic) and my ENT will only > > take care of my sinuses.  He will not have anything to do with my TMJ. > > Is there some law that says ENT doctors are not allowed to treat TMJ > > pain and swelling?  Why do they always refer you to a dentist (oral > > surgeon)?  The TMJ is a "joint"(just smaller than the other joints in > > your body) and is NOT in my mouth or connected to my teeth in any way, > > (so why a dentist)?  Okay, ENT docs, fess up!

Response:

Well, looks like I’m getting the same kind of response from the ENT docs on here, that I get from my own ENT doc, which is "no response".     Thanks!   – Hide quoted text — Show quoted text -<se…@prodigy.net> wrote in message news:38A3A396.2F579F37@prodigy.net… > Why won’t my ENT doc have anything to do with my TMJ?  It is part of my > face and head.  It is between my nose and my ears.  It just happens to > be a "joint", is that the reason?  This makes no sense to me.  I will > get a swollen TMJ along with my sinusitis (chronic) and my ENT will only > take care of my sinuses.  He will not have anything to do with my TMJ. > Is there some law that says ENT doctors are not allowed to treat TMJ > pain and swelling?  Why do they always refer you to a dentist (oral > surgeon)?  The TMJ is a "joint"(just smaller than the other joints in > your body) and is NOT in my mouth or connected to my teeth in any way, > (so why a dentist)?  Okay, ENT docs, fess up!

Response:

Why won’t my ENT doc have anything to do with my TMJ?  It is part of my face and head.  It is between my nose and my ears.  It just happens to be a "joint", is that the reason?  This makes no sense to me.  I will get a swollen TMJ along with my sinusitis (chronic) and my ENT will only take care of my sinuses.  He will not have anything to do with my TMJ. Is there some law that says ENT doctors are not allowed to treat TMJ pain and swelling?  Why do they always refer you to a dentist (oral surgeon)?  The TMJ is a "joint"(just smaller than the other joints in your body) and is NOT in my mouth or connected to my teeth in any way, (so why a dentist)?  Okay, ENT docs, fess up!

Response:

Filed under: Maxillary sinusitis

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