Deviated Septum/Sinus issues

cpilotw

Filing Flight Plan
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cpilotw
After compiling my medical records in preparation for my medical (have yet to schedule with AME...considering visiting an AME that is capable of handing possible tough medical cases such as Dr. Bruce himself), I noticed I had multiple trips to ENT in the past three years for possible allergies (post nasal drip, etc.) due to work performed during the BP Oil Spill. However, after much research, I've begun to think that it is possibly related to my deviated septum.

Back in 2005-06ish, I broke my nose playing football with my 6'6'' uncle (I'm 5'7'' now, but probably shorter then...smart, huh? :no:
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). I had the surgery performed in Summer 2006 but it wasn't fixed entirely. The ENT that performed this surgery is different than the one who I've been seeing for the past three years.

Anyhow, per the diagnosis sheets from this new ENT doctor, he had diagnosed me with sinusitis (doesn't say chronic), possible LPR or PAR, and possible GERD. He is the type of doctor that will say you "might" have something and persisted on trying medication such as Prilosec, etc. to rule out items. He always commented on my deviated septum. When I close the "normal" side, and breathe in and out of the smaller nostril, there is both an audible difference and air flow difference compared to if I closed the smaller nostril and breathed with the normal nostril. Never have I felt out of breath or anything.

Below are my concerns in relation to my medical:

1) Should I schedule another appointment to ensure that it isn't chronic sinusitis? Or possibly with my deviated septum? I've noticed no sinus issues while climbing or descending or any pressure changes for that matter. My chief complaint is what feels like post nasal drip ALL the time.

2) Will the FAA or AME note how often I've visited a type of doctor, say the ENT in this case? Since 2009, I've visited this particular ENT doctor 5 times.

3) Dr. Bruce, I plan on having consultation with you per your website. I am in the process of gathering all of my medical records and compiling an excel spreadsheet of what the 8500 form requests (Date, Name, Reason etc.). What all is necessary to include in the "Reason" - why I visited that physician, what was done, outcome (diagnosis, if any)?

My ENT doctor knows I am a pilot and how serious having an medical is. He is willing to write any letters, if needed, stating what is required by the FAA in order for me to obtain a medical. As long as my diagnosis is accurate and is allowed by the FAA, of course.
 
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I had surgery to correct my deviated septum. Reported it when applying for my most recent third class. No issues.
FWIW the surgery didn't really help. I still have a chronically stuffy nose.
 
cpilotw, if your ENT is willing to write that you have had "recurrent sinusitis but have not had chronic sinusitis", you will be okay with the AME, provided your exam is negative.

It's even better if he leaves out the "recurrent". I doubt that the posterior deviation is causing you to have recurrent drainage troubles- but you have to rely on your ENT for an assessment of that one.
 
Thank you, Dr. Bruce!

Scheduled to see ENT this afternoon and made it known to the receptionist that answered the phone call that I need a "full sinus evaluation for the FAA"...I'll be suprised if that part of the message was relayed to my doctor...

I had an Upper GI endoscopy done last year as a further diagnositc by my Gastroenterologist and to my memory, everything was normal. From my understanding, this rules out GERD. I'm going to obtain a copy of my results from my Gastro today before seeing my ENT.

I'm either going to guess it's because my deviated septum (sources indicate that this can cause post nasal drip- being my primary complaint), allergies, or both....possibly sinusitis even.

Will update on this issue.
 
Thank you, Dr. Bruce!

Scheduled to see ENT this afternoon and made it known to the receptionist that answered the phone call that I need a "full sinus evaluation for the FAA"...I'll be suprised if that part of the message was relayed to my doctor...

I had an Upper GI endoscopy done last year as a further diagnositc by my Gastroenterologist and to my memory, everything was normal. From my understanding, this rules out GERD. I'm going to obtain a copy of my results from my Gastro today before seeing my ENT.

I'm either going to guess it's because my deviated septum (sources indicate that this can cause post nasal drip- being my primary complaint), allergies, or both....possibly sinusitis even.

Will update on this issue.
An EGD does not rule out GERD, only esophagitis or Barret's esophagus which are complications of GERD. It is possible to have GERD with no tissue damage. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001311/
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002128/
http://www.mayoclinic.com/health/barretts-esophagus/HQ00312
 
Interesting. So, I am a bit confused going into this appointment this afternoon.

What should I ask the ENT to perform so I can possibly confirm a diagnosis for FAA purposes of obtaining a medical?

Considering deviated septum, constantly clearing my sinuses and swallowing the phlegm (probably not the smartest...although when I can bring the mucous out of my body through the mouth it's usually clear, whitish in color.

If it is GERD, which rx - Nexium, Prilosec? I don't have any ulcers per my upper GI Endoscopy.

If it is Sinusitis, which rx - Flonase? OTC better solution?

If it is chronic post nasal drip, what is there to do?

This problem is more annoying than anything...no pain really. I do live in Louisiana...allergies are a HUGE problem for many residents. If that is the case, nasal irrigation and any OTC or Rx recommended?

Knowing this doctor, I want to have options that are allowed by the FAA. Hopefully the outcome will agree with the FAA.
 
Just got home from my ENT appointment. Everything went really well. This Doctor is very understanding and supportive of my passion for aviation, while being honest and knowledgeable at the same time.

He doesn't think I have chronic sinusitis. I've tried Prilosec in the past when he wanted to conservatively treat possible GERD; didn't do much for me.

He concluded that it's probably allergies as pretty much everyone in the State of Louisiana suffers from it due to our unfortunate climate patterns, whether it be seasonal or chronic. I asked to try Flonase (Fluticasone) so he prescribed me such and just took my first dose. Will monitor the side effects of this medication, as it was prescribed to assist with the Post Nasal Drip that I've been experiencing.

As far as my deviated septum, he believes the outcome of the surgery could've been much better (he didn't perform the surgery as stated in the OP), however he did mention that it's an option to attempt to correct what appears to be the septum towards the actual entrance/exit of the nostrils, which is the most deviated. The septum further up the nose is fairly straight. The Dr mentioned that it is possible for deviated septum to cause PND due to blockage of mucous from the sinuses, however he is unsure as to if my that is the case with my deviated septum.

All in all, the appointment went well. I printed out approved Rx list and brought a copy of my Upper GI. He was more than happy to write a script for Flonase, feeling confident that this may help. In addition, he said he would write a letter for me, all that is required of me is that I send him an email with some "talking points" such as the condition of my deviated septum and its effect on breathing, etc. My guess is I will request that he state what Dr. Bruce mentioned above as well as any evidence that he can show, per his evaluation today and other times, that allergies seem to be the cause. Any input on what else would suffice, considering the attempt to be treated for GERD, etc., please let me know.

Thank you for all the great feedback. I really appreciate the knowledge and support provided from this community.
 
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