After a recent CT scan, my husband's doctor said he had thickening of the sinuses and needs to see a specialist. What does thickening of the sinuses mean, and what possible treatments are there?

Wendy

Sinuses are nothing more than air pockets in the bones of the face. These air pockets are lined with a very thin layer of mucosa, the same tissue that lines the nasal cavities. On a CT scan, mucosa is usually not seen. There is a crisp border between facial bone (which is white on CT) and the air contained in the sinus (which is black on CT). If the mucosa is thickened, it will be evident as a gray layer interposed between the white (bone) and the black (air).
Mucosal thickening suggests chronic inflammation. This, in turn, could be due to allergies and/or chronic bacterial inflammation. It could also be an incidental finding. In other words, your husband may have mucosal thickening yet have no symptoms of illness.

Every medical student is taught to treat patients, not X-rays. (No, we did NOT need Patch Adams to teach us this!) Before talking about treatment of mucosal thickening, it is thus important to ask whether it needs to be treated at all.

Why did your husband have the CT scan in the first place? If he had the scan for a reason other than a sinus or nasal complaint, then sinus mucosal thickening is probably irrelevant. Even if he did have the scan because of a sinus or nasal complaint (for example, nasal congestion or recurrent sinus infections), then it is still valid to ask, "Is the mucosal thickening the cause of his sinus or nasal problems?"

That's where the specialist comes in. Your husband's doctor does not feel competent to judge the significance of this CT finding, so he is asking the specialist (an ear, nose and throat doctor, I would assume) to comment on it. He is being a responsible doctor. To quote Harry Callahan (Clint Eastwood, in Magnum Force), "A man's gotta know his limitations."

A good ear, nose and throat specialist (ENT) will focus on your husband's sinus or nasal symptoms and not get too sidetracked by the CT. The CT is just a bit of data. If your husband requires treatment, it will be treatment aimed at relieving his symptoms, not improving the appearance of his CT.

Without knowing your husband's symptoms, I cannot guess what his treatment might entail. He may need aggressive medical treatment for a chronic sinus infection, or perhaps he needs to be treated for allergy -- or perhaps both. An operation may be necessary at some point, but most ENTs will exhaust the medical options (assuming there are reasonable options) before resorting to surgery.