This past year has been more challenging than most modern-day humans have ever experienced. The world became attacked by a biological assault from a new virus, COVID. With social distancing, stay at home orders, masks, zoom meetings and home working/school, the world shut down. Telehealth became a new and streamlined method for healthcare which allowed patients and providers to continue to be cared for in a safe atmosphere away from possible infection. This served a vital need, but it does require some basic computer comfort to obtain and manage a communication link between the two entities. Unfortunately, not everyone is comfortable with computerized communications. This method also removes the ability of the provider to physically examine the patients to determine a most accurate diagnosis.
Challenges Presented for Patients and Ear, Nose, and Throat Doctors
New challenges arose for both patients and providers as they were not able to meet with one another in-person. This was the case for my 78-year-old patient, James, that I recently saw. James felt that his worsening nasal symptoms were due to either a deviated nasal septum or simple uncontrolled allergies. James came to me with nasal obstruction on the right side. His symptoms included persistent worsening nasal drainage, facial pain, loss of smell, allergies, and postnasal drainage.
During the pandemic he was tested three different times and his results came back negative each time. He has tried Flonase, antihistamines, decongestants, analgesics, and saline nasal spray all without any improvements. He denies any nose bleeds, dental issues, fever, recent sinus infections, travel, trauma, head or neck tumors, sleep troubles, or infection exposures. He has a history of hypertension, deep vein thrombosis, cataracts, and prostate cancer (in remission). James smokes cigars regularly and drinks 1-2 alcoholic drinks per day. He is an ex-cigarette smoker with a 20+ pack/year history.
Making the Most of Your First Appointment with Your Ear, Nose, and Throat Doctor
During his first appointment at Sinus and Allergy Wellness Center, I performed a physical examination on him which showed a right sided nasal airway obstruction due to unilateral nasal polyps. The septum was deflected to the opposite side and there was clear watery nasal drainage noted worse on the right side. In our office during his first appointment, we also performed a CT scan which showed an almost complete nasal/sinus opacification on the right side which basically means that the nose and sinuses on the right side were almost filled with either an infection, polyps or a tumor. It was pushing his septum to the opposite side and the imaging view at the top of the nose (commonly referred to as the skull base) showed thinning and possibly erosion for the bone which separates the nose from the brain.
I shared the findings with James and ordered an MRI scan which was needed to clearly determine if this opacification extended through the nasal cavity into the intracranial cavity. Unfortunately, my suspicions were accurate, and the MRI scan did indeed show that the opacification within the nasal cavity did extend through the thin bone of the skull base into the brain. Our working diagnosis is an Esthesioneuroblastoma. This type of growth is a malignant rare tumor of the sinonasal region. Typically, these tumors are treated with surgical excision and then chemotherapy as well as radiation therapy to help reduce the potential for the growth to reoccur.
James felt that his symptoms all began during the pandemic, these tumors are generally slow growing, and James’ tumor was probably present for a number of years prior to the COVID pandemic. A definitive biopsy is forthcoming.
Why It is Important to Visit Your Ear, Nose, and Throat Doctor As Soon as Symptoms Appear
While James’ tumor was probably present during the COVID pandemic, if it was diagnosed earlier, it may have been easier to treat with a better outcome than it is at the current state. While the COVID pandemic presented a barrier to routine Ear Nose and Throat (or any other medical provider) access for evaluation and treatment, remember when your symptoms show no signs of improvement, it is important to be evaluated and treated no matter how benign you may think the problem may be. Earlier diagnosis usually provides best outcomes. Nasal/sinus problems are usually benign and easily treated but when the trouble persists or worsens, please seek medical attention as soon as possible. Basically, more time = more options.