Sinusitis: Persistent Symptoms and Treatment Options - Otolaryngology

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Regarding sinusitis issues?


Hello, Doctor! Since last year, I have been experiencing issues with yellow nasal discharge, but I did not seek active treatment.
Occasionally, when I blow my nose forcefully, there are streaks of blood, and I experience alternating nasal congestion in both nostrils.
I also have a history of allergic conditions (with elevated eosinophil counts during health check-ups).
I first consulted at a clinic, where the doctor diagnosed me with allergic rhinitis and sinusitis, along with a deviated septum.
After taking antibiotics for about three weeks, the yellow nasal discharge has decreased, but I still intermittently experience the same issues.
Later, I went to a larger hospital because I was concerned about the possibility of nasopharyngeal cancer due to the blood streaks.
The doctor performed a nasal endoscopy and X-ray, and after the examination, he indicated that I only had sinusitis and did not find any polyps or tumors that I was worried about.
He prescribed a different antibiotic for me.
I would like to ask the doctor why, after nearly a month of antibiotics, the yellow nasal discharge has improved somewhat but still persists.
Will I need to take medication for a longer duration? This is really troubling me! Thank you, Doctor, for your patience in reading and responding!

Jason, 30~39 year old female. Ask Date: 2016/08/19

Dr. Ji Zhaoyun reply Otolaryngology


Hello Jason, if acute sinusitis persists despite antibiotic treatment for more than two weeks, it is recommended to visit an otolaryngologist for bacterial culture.
If a "more virulent" bacteria is identified, it may be necessary to switch to a stronger antibiotic.
I suggest you purchase a "nasal irrigator" (containing isotonic saline) and perform rinsing 1-2 times daily to enhance the treatment effects of sinusitis.
Additionally, avoid staying up late and refrain from smoking.
For individuals with diabetes, it is essential to control blood sugar levels.
If sinusitis has not improved after 2-3 months of treatment, it is highly likely to be "chronic" sinusitis, which requires further examination.
If necessary, surgical intervention may be required.
I recommend seeking evaluation from an otolaryngologist.
Wishing you safety and health.
Sincerely, Dr.
Chi Chao-Yun, Head of the ENT Department, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2016/08/19

More Info


Understanding sinusitis, particularly in the context of persistent symptoms and treatment options, is crucial for managing your health effectively. Based on your description, it appears you are dealing with a combination of allergic rhinitis and sinusitis, which can complicate your symptoms and treatment outcomes.

Sinusitis, or inflammation of the sinuses, can be acute or chronic. Chronic sinusitis is often characterized by symptoms lasting more than 12 weeks, including nasal congestion, facial pain or pressure, and discolored nasal discharge, which you have described as yellow mucus. The presence of blood-streaked mucus can be concerning, but as your recent examinations have ruled out serious conditions like nasal tumors or polyps, it is likely a result of irritation or inflammation in the nasal passages.

The fact that you have a history of allergic rhinitis (as indicated by elevated eosinophils) suggests that your nasal passages may be more reactive to environmental allergens, which can exacerbate sinusitis symptoms. Allergens can lead to increased mucus production and swelling of the nasal tissues, contributing to blockage and subsequent sinus pressure and pain.

Regarding your treatment, it is not uncommon for antibiotics to take time to show significant improvement, especially if the sinusitis is chronic or if there are underlying allergic factors at play. Antibiotics are effective against bacterial infections, but if your sinusitis is primarily due to allergies or viral infections, antibiotics may not provide the relief you seek. Additionally, the presence of nasal obstruction due to a deviated septum can hinder drainage from the sinuses, making it difficult for the antibiotics to work effectively.

Here are some treatment options and considerations for your situation:
1. Longer Course of Antibiotics: If your symptoms persist despite initial treatment, your doctor may consider extending the course of antibiotics or switching to a different class of antibiotics that may be more effective against the specific bacteria involved.

2. Nasal Corticosteroids: These can help reduce inflammation in the nasal passages and sinuses, improving drainage and reducing congestion. They are particularly useful for managing symptoms of allergic rhinitis and can be used alongside antibiotics.

3. Saline Nasal Irrigation: Regularly rinsing your nasal passages with saline solution can help clear mucus and allergens, reduce nasal congestion, and promote sinus drainage. This is a safe and effective adjunct therapy for sinusitis.

4. Allergy Management: Since you have a history of allergies, working with an allergist to identify and manage your triggers can significantly improve your symptoms. This may include the use of antihistamines or allergy shots (immunotherapy).

5. Surgery: If you have persistent symptoms despite medical management, and if structural issues like a deviated septum are contributing to your sinusitis, surgical options may be considered. Functional endoscopic sinus surgery (FESS) can help improve sinus drainage and reduce the frequency of sinus infections.

6. Follow-Up Care: Regular follow-ups with your ENT specialist are essential to monitor your condition and adjust treatment as necessary. If your symptoms do not improve or worsen, further imaging studies or referrals to specialists may be warranted.

In summary, managing sinusitis, especially when complicated by allergies, requires a comprehensive approach that includes medication, lifestyle changes, and possibly surgical intervention. It is essential to maintain open communication with your healthcare providers to find the most effective treatment plan tailored to your specific needs.

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