Persistent Throat Pain and Thick Mucus: Sinusitis and Treatment Options

Sinusitis/post-nasal drip/sore throat/thick phlegm?

Hello Doctor, at the beginning of January this year, I visited a doctor for a sore throat and took cold medication for nine days.
After that, I started coughing up thick phlegm with blood about once a week.
By the end of February, I couldn't stand it anymore and consulted another doctor.
The doctor helped me with sputum extraction and noted that the phlegm was very thick and stuck in the back of my throat.
Due to post-nasal drip, I was prescribed antibiotics and expectorant effervescent tablets.
After taking antibiotics for 15 days, the phlegm remained thick, and the doctor switched my antibiotics.
I felt some improvement in my symptoms, so I stopped seeing the doctor.
When I wasn't on medication, I still produced a lot of phlegm, and my throat continued to hurt.
In early April, I returned to the same doctor, who mentioned that it had been several months without improvement and diagnosed me with sinusitis.
I took another 15 days of antibiotics, but the thick phlegm and sore throat persisted.
Later, I went to a larger hospital for an X-ray (and also had an endoscopy, where the doctor said my nasal passages were clear).
The doctor reviewed the X-ray and noted that the phlegm had decreased, so I was prescribed expectorant effervescent tablets and antihistamines.
However, my throat still hurts, and I continue to cough up thick phlegm (which is light yellow with some blood streaks).
I would like to ask the doctor what I can do about my condition now.
What other tests can I undergo? Is there a possibility of other diseases? My main symptoms are that no matter how many days of antibiotics I take, I still have thick phlegm stuck in the back of my throat and a sore throat.
Thank you, Doctor, for your response.

Xiao Qie'e, 20~29 year old female. Ask Date: 2020/04/18

Dr. Zheng Jueyi reply Otolaryngology

Hello, if the symptoms persist without improvement, they are often related to post-nasal drip or pulmonary diseases.
If the ENT examination is normal, it is recommended to consult a pulmonologist for further evaluation.
Wishing you peace and health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the ENT Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2020/04/18

More Info

Persistent throat pain and thick mucus can be quite distressing, especially when they are accompanied by a history of sinusitis. Based on your description, it seems that you have been dealing with these symptoms for several months, and despite multiple courses of antibiotics and other treatments, you have not achieved significant relief.
Sinusitis, particularly chronic sinusitis, can lead to post-nasal drip, which is when mucus accumulates in the back of the throat due to inflammation and blockage of the sinus passages. This can cause throat pain, a sensation of mucus in the throat, and coughing, especially when lying down or during the night. The presence of thick, discolored mucus, especially with blood, can indicate ongoing inflammation or irritation in the respiratory tract.

Given your ongoing symptoms, here are several steps you might consider taking:
1. Follow-Up with an ENT Specialist: Since you have already seen a doctor and undergone imaging and endoscopy, it may be beneficial to revisit an Ear, Nose, and Throat (ENT) specialist. They can perform a thorough examination and may recommend further diagnostic tests, such as a CT scan of the sinuses, to assess for any underlying issues that may not have been visible on X-ray.

2. Consider Allergy Testing: Allergies can contribute to chronic sinusitis and post-nasal drip. If you have not already been tested for allergies, this could provide insight into potential triggers that exacerbate your symptoms.

3. Nasal Irrigation: Regularly using saline nasal sprays or performing nasal irrigation (e.g., with a neti pot) can help to clear mucus and allergens from the nasal passages, potentially reducing post-nasal drip and throat irritation.

4. Hydration and Humidification: Staying well-hydrated can thin mucus, making it easier to expel. Additionally, using a humidifier in your home, especially during dry seasons, can help keep your nasal passages moist and reduce irritation.

5. Consider a Different Class of Medications: If you are still experiencing significant symptoms, it may be worth discussing with your doctor the possibility of trying different classes of medications. For example, nasal corticosteroids can help reduce inflammation in the nasal passages, while mucolytics can help thin mucus.

6. Evaluate for Other Conditions: If your symptoms persist despite treatment, it may be worthwhile to evaluate for other conditions that could mimic or contribute to your symptoms, such as gastroesophageal reflux disease (GERD), which can cause throat pain and mucus production.

7. Lifestyle Modifications: Avoiding irritants such as smoke, strong odors, and pollutants can help reduce throat irritation. Additionally, elevating the head while sleeping can help reduce post-nasal drip.

8. Monitor Symptoms: Keep a detailed log of your symptoms, including when they occur, their severity, and any potential triggers. This information can be invaluable for your healthcare provider in determining the best course of action.

In summary, while chronic sinusitis can be a challenging condition to manage, there are various strategies and treatments available. It is essential to maintain open communication with your healthcare providers, advocate for your health, and explore all potential avenues for relief. If you continue to experience symptoms, do not hesitate to seek further evaluation and treatment options.

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