Managing Sinusitis Symptoms: When to Consider Surgery or Medication

What should I do to manage symptoms of sinusitis?

Last year, I had a health check-up and was diagnosed with mild sinusitis.
However, I only experience nasal discharge after allergies or a cold, and I don't have a runny nose.
My nasal passages always feel congested, and while I can't blow out mucus, I can suction it out with force.
I frequently have headaches, and there's a persistent metallic taste in my mouth, along with bad breath.
Sometimes, this even leads to tooth pain.
I'm unsure if this condition requires surgical treatment or if it can be managed with medication.
Thank you for taking the time to respond; I appreciate it.

Mr. Chen, 30~39 year old female. Ask Date: 2019/02/18

Dr. Ji Zhaoyun reply Otolaryngology

Hello, common symptoms of sinusitis include nasal congestion, yellow-green nasal discharge, fever, facial pain, foul smell, and changes in smell, although not all symptoms may appear.
Diagnostic methods include endoscopy and imaging studies.
If acute sinusitis persists despite antibiotic treatment for more than two weeks, it is recommended to consult an otolaryngologist for bacterial culture.
If a "more virulent" bacteria is identified, it may be necessary to switch to a stronger antibiotic.
It is suggested to purchase a "nasal irrigator" (containing isotonic saline) and perform rinsing 1-2 times daily to enhance the treatment effect of sinusitis.
Additionally, avoid staying up late, refrain from smoking, and individuals with diabetes should control their blood sugar levels.
If sinusitis has not resolved after more than 2-3 months of treatment, it is highly likely to be "chronic" sinusitis, which requires further examination.
If necessary, surgical intervention may be needed.
It is advisable to seek evaluation from an otolaryngologist.
Wishing you peace and good health.

Sincerely,
Dr.
Chi Chao-Yun,
Director of Otolaryngology, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2019/02/18

More Info

Managing sinusitis symptoms can be quite challenging, especially when they persist despite various treatments. Based on your description, it sounds like you are experiencing chronic sinusitis symptoms, which can include nasal congestion, headaches, post-nasal drip, and even dental pain due to the proximity of the sinuses to the upper teeth.
Chronic sinusitis is often characterized by inflammation of the sinuses that lasts for more than 12 weeks, and it can be triggered by allergies, infections, or structural issues within the nasal passages. The symptoms you mentioned, such as the sensation of mucus in the nasal cavity, headaches, and a bad taste in your mouth, are common in individuals with sinusitis. The presence of a blood taste in your mouth could be due to several factors, including post-nasal drip, where mucus drips down the back of the throat, or even minor bleeding from irritated nasal passages.

When it comes to treatment, both medication and surgery can be options, depending on the severity and persistence of your symptoms. Here are some considerations for each approach:

Medication Management
1. Nasal Corticosteroids: These can help reduce inflammation in the nasal passages and sinuses. They are often the first line of treatment for chronic sinusitis.

2. Saline Nasal Irrigation: This can help clear out mucus and allergens from the nasal passages, providing relief from congestion.

3. Antibiotics: If your sinusitis is caused by a bacterial infection, a course of antibiotics may be necessary. However, they are not effective against viral infections.

4. Decongestants: These can help relieve nasal congestion but should be used cautiously and not for extended periods.

5. Antihistamines: If allergies are a contributing factor, antihistamines can help reduce symptoms.

Surgical Options
If medication fails to provide relief, or if you have structural issues (like nasal polyps or a deviated septum) that contribute to your sinusitis, surgery may be considered. The most common surgical procedure for chronic sinusitis is Functional Endoscopic Sinus Surgery (FESS), which aims to clear blocked sinuses and restore normal drainage.

When to Consider Surgery
- Persistent Symptoms: If you have been experiencing symptoms for an extended period (typically more than 12 weeks) without significant improvement from medication.

- Frequent Infections: If you have recurrent sinus infections that require multiple courses of antibiotics.

- Structural Issues: If imaging studies (like a CT scan) reveal anatomical problems that could be corrected surgically.

Additional Considerations
Before making a decision, it is essential to consult with an Ear, Nose, and Throat (ENT) specialist who can evaluate your specific situation. They may recommend imaging studies to assess the sinuses and determine the best course of action.
In summary, if your symptoms are significantly impacting your quality of life and conservative treatments have not been effective, it may be time to discuss surgical options with your healthcare provider. They can help you weigh the risks and benefits of surgery versus continued medical management based on your individual case.

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