Sinus advice. Hoping for some good suggestions

[RichardThailand]

I'm posting here in the hope that I can get some advice on sinus treatment. My girlfriend has the problems, she's been to a doctor twice now and I'd like to also get some advice from some of them members here. I posted before and a few people had comments about sinus issues and pollution that were helpful. Hopefully I can get some treatment advice too. Here's the background.

My girlfriend has had on and off sinus issues for a long time with the sinus on the right side of her face. Not so much blocked sinus but she has been having sinus headaches that come whenever she gets a cold, when she's in cold air or when she's flying (sometimes). Recently she caught a cold and then about a week later after the cold had gone she started to experience a headache which I think was in the area of her top right hand sinus. This lasted a few days before we decided to go to the ENT at Vejthani hospital. At the hospital the doctor saw the back of her throat had some dripping and a CAT scan showed her left sinus clear and her right sinus (especially at the top) blocked. The scan showed almost 90% was mucus with a small area in the center

Week 1 - tests: CAT scan

Week 1 - treatment:

Augmentin (1g) - Take one tablet 2 times after breakfast and dinner - Antibiotic

Arcoxia (90mg) - Once daily after breakfast - For pain and inflammation

CRAvit (500 mg) - Once daily after breakfast - Antibiotic

Xyzal (5mg) - Once before bedtime - Antihistamines

Nasonex (0.05% nasal spray) - 2 times morning and evening. Spray into each nostril 1 puff - Nasal spray

After the meds her headache went away after about 24 hours. A few days later her nose was not feeling blocked up. One week later she saw a doctor who still saw nasal drip at the back of her throat and changed her to these meds:

Week 2 - tests: Blood tests for allergy

Week 2 - treatment:

Azithromycin (250mg Floctil) - Take 2 capsule once daily - Antibiotic

Prednisilone (5mg) - Take 2 tablet 2 times after breakfast and dinner - For inflammation

Otrivin (0.1%) - Spray into each nostril 1 puff. Every 8 hours when you have symptoms - For nasal congestion

Telfast (180mg) - Take 1 tablet before bedtime - Antihistamines, for runny nose, for itching

Now she has another appointment tomorrow. Her nose feels okay but we are still not sure if there is any way to know if the infection has gone without another CAT scan. The doctor has also suggested endoscopy to take a sample of the mucus for testing so he could target the bacteria in the most effective way.

Would appreciate any advice anyone can give. We don't want to move ahead with anything aggressive but at the same time we're not sure even if the problem has been solved at all.

Edited February 22, 2016 by RichardThailand

[ttthailand]

I would think that by her being given Prednisilone that the doctor believes the infection is not the issue and the current problem is just that her sinus is inflamed and normal drug treatment is not enough. Prednisilone is a steroid and anti-inflammatory that will help her body suppress the production of mucus. It will help to shut this down until a point that her body reacts normally again.

[ttthailand]

I would wait until she is off of all the drugs to see if the mucus issue is resolved. The Prednisilone should be decreased to perhaps 5mg for a few days after the 2 x 2 treatment is finished. Her body should then return to normal. I have similar issues so I understand.

[RichardThailand]

I would think that by her being given Prednisilone that the doctor believes the infection is not the issue and the current problem is just that her sinus is inflamed and normal drug treatment is not enough. Prednisilone is a steroid and anti-inflammatory that will help her body suppress the production of mucus. It will help to shut this down until a point that her body reacts normally again.

Do you have any ideas as to for how long it might be safe to continue this drug. Now that she does not have any symptoms we're wondering if the top sinus have really been completely cleared or if they still are still blocked. For sure the right side is not as bad as she no longer has any headache but seems like the only way to see if they are completely clear is another CAT scan.

[tonray]

I would think that by her being given Prednisilone that the doctor believes the infection is not the issue and the current problem is just that her sinus is inflamed and normal drug treatment is not enough. Prednisilone is a steroid and anti-inflammatory that will help her body suppress the production of mucus. It will help to shut this down until a point that her body reacts normally again.

Prednisilone use is a slippery slope. Long term use will suppress your own adrenal gland's ability to function. Also will lead to bloating, constipation and a host of other things. When time to quit you need to be weaned off of it otherwise your body suffers withdrawal and symptoms come back worse than ever. I would re-consider using oral steroids.

[Sheryl]

Best I can do is suggest she consult Prof. Songklot at St. Louis Hospital for another opinion.

[rodknock]

years ago i had acute sinusitis in the frontal sinus cavity's(over the eye). sinus would not drain and get infected, push the eye ball out of it's socket. in 2 years i spent 6months in the hospital on iv antibiotics, with numerous operations to try and allow the sinus to drain. the final result was they did what is called a "frontal sinus obliteration". cut the scalp over the head, pull down the scalp, cut the sinus cavity's open and pack them with body fat. wire the bone back, pull the scalp back and staple.

this is a definitive surgery. worked for me, have not had problems, infection, pain or drainage ever since. was done in 1985.

spoke to an ENT doctor here in Bangkok and they had never heard of that surgery.

good luck, i know how bad sinus pain can be.

[tonray]

years ago i had acute sinusitis in the frontal sinus cavity's(over the eye). sinus would not drain and get infected, push the eye ball out of it's socket. in 2 years i spent 6months in the hospital on iv antibiotics, with numerous operations to try and allow the sinus to drain. the final result was they did what is called a "frontal sinus obliteration". cut the scalp over the head, pull down the scalp, cut the sinus cavity's open and pack them with body fat. wire the bone back, pull the scalp back and staple.

this is a definitive surgery. worked for me, have not had problems, infection, pain or drainage ever since. was done in 1985.

spoke to an ENT doctor here in Bangkok and they had never heard of that surgery.

good luck, i know how bad sinus pain can be.

Most sinus surgeries are done either thru the nose or via the upper palate these days. I am not sure the radical procedure you had is done very frequently even in the west.

[gamini]

My wife has had serious sinus problems. We moved to a quiet beach not far from Hua Hin, where there is no pollution and her sinus cleared up. Incidentally oral steroids should not be taken for more than 6 days. That is why your doctor only gave you 30 tabs. You should not self medicate using steroids.

[Sheryl]

Also need to be sure there is no infection before taking steroids, as they suppress the immune response.

[puck2]

Why didn't you googel: sinmus natural treatment

This was helpful for me (and cheap, too): #1 of

http://www.everydayhealth.com/sinus-health-guide/natural-remedies-for-sinus-pain.aspx

[xylophone]

Have had sinus problems on and off over the years, sometimes so severe that I just can't function.

The antibiotics your girlfriend were prescribed at the first consultation would have cured a horse, pretty potent stuff!!

Two of the best solutions in my case were the removal and straightening of the septum, way back in the mid-80s in New Zealand, because according to the specialist my septum was bent and stopping a good airflow through the sinuses which helps prevent infection. This just about cured my sinus problems until just a few years ago when I started getting them again here and I saw a specialist in Bangkok Phuket hospital.

He was a young guy and extremely thorough I have to say, taking a scan of the sinuses and looking around in the sinus cavities with his little "camera scope". He managed to find some infected mucus and drained this on three visits, along with a prescribed antibiotic (can't remember which one now) and prednisone was prescribed to help reduce inflammation.

Nasonex was great in clearing the airways to allow everything to work and I also got onto flushing out the sinuses on a daily basis with saline solution, with the addition of a small amount of Mupirocin cream dissolved in it (Google this and the Mayo clinic for more information as their initial tests have proven encouraging).

Now I seem to be in a situation where everything is working okay and I only occasionally use the Nasonex, however the almost daily rinses with the saline solution are something I will continue with for a long time into the future.

So in a nutshell, ensure that there is no physical problem with regard to the airways and sinus passages, then get the infection treated, along with the inflammation and quite possibly some sort of drainage, then try the saline plus Mupirocin daily flushing.

I hope this helps as sinus problems can be so debilitating.