Recurring Sinusitis: Symptoms, Causes, and Treatment Options

Questions regarding the recurrence of sinusitis and related issues?

Hello Doctor, I would like to inquire about sinusitis.
Symptoms: left-sided unilateral sinusitis, minimal nasal congestion, post-nasal drip, left-sided headache, and facial swelling.
Medical history: I have had sinusitis for over a year, with no prior issues.
However, symptoms began to gradually appear two years ago.
I frequently visited doctors, and while I would improve, the condition would recur.
Earlier this year, I consulted at Tzu Chi Hospital, where I underwent X-rays and a CT scan, and was prescribed antibiotics, which effectively cleared the infection.
Each follow-up X-ray showed improvement, but the symptoms would return after a few weeks.
Initially, the doctor suspected it might be fungal sinusitis and recommended surgery.
However, after the CT scan, he indicated that the issue seemed to be related to the structure of my nasal cavity, which hinders the drainage of sinus secretions, and also suggested surgery.
He advised me to perform nasal irrigation.
Currently, I have been doing nasal irrigation for about 3-4 months, and my condition has improved significantly, but sinusitis still occasionally recurs.
Recently, with the changing weather, it seems to have flared up again, with unilateral nasal swelling and pain, along with unilateral headache.
There is minimal nasal congestion, but post-nasal drip persists.
I found online that antibiotics are ineffective for fungal sinusitis, but they worked for me initially, although the condition recurs.
I would like to ask the doctor if surgery is necessary if it is indeed fungal sinusitis.
I have managed to alleviate my sinusitis significantly through nasal irrigation over the past 3-4 months, but sometimes when I neglect it for about a week, the symptoms return.
Are these symptoms due to structural issues in the nasal cavity, or could they be related to nasal allergies?

Mr. Wang, 20~29 year old female. Ask Date: 2017/10/17

Dr. Li Jiaxuan reply Otolaryngology

Chronic sinusitis that has not eradicated the source of infection is indeed prone to recurrence.
Frequent recurrences or excessive nasal discharge are conditions that may warrant surgery.
However, the decision to undergo surgery ultimately depends on your acceptance of the procedure.
Individuals who are more resistant to surgery may opt for nasal irrigation and medical treatment for 1-2 years before considering surgery.
It is important to note that fungal infections are more invasive than typical bacterial infections, so one should be vigilant for any eye discomfort and regularly follow up in the clinic.
Nasal allergies and structural issues in the nasal passages can also contribute to the difficulty in recovering from sinusitis and its frequent recurrences.
This is similarly true after simple sinus surgery.
Therefore, if you decide to undergo sinus surgery, you may ask your physician to also address any nasal structural issues.
Wishing you a safe procedure.

P.S.
Fungal infections often occur following a bacterial infection, so taking antibiotics can effectively suppress bacteria, but may not eliminate the fungi.

Reply Date: 2017/10/17

More Info

Understanding recurring sinusitis, especially in the context of your symptoms and medical history, is crucial for effective management and treatment. Sinusitis, or inflammation of the sinus cavities, can be acute or chronic, with chronic sinusitis lasting longer than 12 weeks and often recurring. Your symptoms of unilateral nasal drainage, facial pressure, and headaches align with common presentations of sinusitis, particularly when associated with structural issues in the nasal cavity.

Symptoms and Diagnosis
The symptoms you describe—left-sided facial pressure, headaches, and post-nasal drip—are indicative of sinusitis. The absence of significant nasal congestion is not uncommon, especially in cases where drainage pathways are obstructed due to anatomical variations. Your history of recurrent episodes, despite treatment with antibiotics and nasal irrigation, suggests that there may be underlying factors contributing to the persistence of your symptoms.

Causes of Recurring Sinusitis
1. Anatomical Variations: As your doctor indicated, structural issues in the nasal cavity can impede proper drainage of the sinuses. Conditions such as a deviated septum, enlarged turbinates, or other anatomical abnormalities can lead to chronic inflammation and blockage, making it difficult for mucus to drain effectively.

2. Allergies and Environmental Factors: Allergic rhinitis can exacerbate sinusitis symptoms. If you have allergies, they may contribute to inflammation in the nasal passages, leading to increased mucus production and subsequent blockage of the sinuses.

3. Infections: While bacterial infections are a common cause of sinusitis, fungal infections can also occur, particularly in individuals with compromised immune systems or specific anatomical predispositions. However, as you noted, antibiotics are ineffective against fungal infections.

4. Chronic Inflammation: Conditions such as asthma or other chronic respiratory issues can lead to persistent inflammation in the sinuses, contributing to recurrent episodes of sinusitis.

Treatment Options
Given your situation, here are some treatment options to consider:
1. Nasal Irrigation: You mentioned that nasal irrigation has significantly helped your symptoms. This is an effective method for clearing mucus and allergens from the nasal passages and can be continued as a part of your daily routine.

2. Medications: While antibiotics are effective for bacterial infections, they may not address underlying structural issues or fungal infections. Consider discussing with your doctor the use of corticosteroids (either nasal sprays or oral) to reduce inflammation in the nasal passages.

3. Allergy Management: If allergies are contributing to your symptoms, allergy testing and subsequent management (such as antihistamines or allergy shots) may be beneficial.

4. Surgery: If structural issues are confirmed to be the primary cause of your recurrent sinusitis, surgical intervention may be warranted. Functional endoscopic sinus surgery (FESS) can help to enlarge the sinus openings, allowing for better drainage and reducing the frequency of infections.

5. Regular Follow-Up: Given the chronic nature of your condition, regular follow-up with an ENT specialist is essential. They can monitor your symptoms, adjust treatment as necessary, and determine if surgical options are appropriate.

Conclusion
In summary, your recurring sinusitis appears to be multifactorial, involving both anatomical and possibly allergic components. While nasal irrigation has provided relief, addressing the underlying causes through a combination of medical management and potential surgical intervention may be necessary for long-term resolution. It is crucial to maintain open communication with your healthcare provider to tailor a treatment plan that best suits your needs and to explore all possible avenues for relief.

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