Dental-Related Sinusitis: Symptoms and Treatment Options

Diagnosis of odontogenic sinusitis?

Hello, doctor.
I would like to ask the following questions:
1.
I first experienced symptoms of sinusitis in 2019, with a CT scan showing pus accumulation in the right maxillary sinus.
After taking antibiotics for a month, I recovered.
Subsequently, I had another episode of sinusitis in May of this year, which resolved after one week of antibiotics.
2.
On September 1, 2023, I underwent tooth extraction due to long-term cavities in my upper right molars.
Before the extraction, the dentist indicated through X-ray that my sinus cavity was relatively low.
After the extraction, I took a seven-day course of amoxicillin prescribed by the dentist.
Five days post-extraction, I experienced pain in my right cheek and post-nasal drip, similar to the symptoms I had in 2019.
After about three weeks of antibiotic treatment prescribed by an ENT clinic, my symptoms did not improve.
At this point, the symptoms were mild, with occasional unilateral nasal congestion and post-nasal drip.
After traveling abroad in the fourth week, I caught a cold, and my sinusitis worsened, presenting with thick nasal discharge and nasal congestion.
Upon returning to the dentist, it was noted that there was a small opening at the extraction site, but the diagnosis of sinusitis could not be definitively linked to the tooth extraction.
The doctor believed that the cold exacerbated my condition and recommended a referral to an ENT specialist, with a follow-up to the dentist after ENT treatment.
3.
On October 14, 2023, I underwent a nasal endoscopy at a major hospital's ENT department, which revealed a significant amount of yellow nasal discharge but no nasal polyps.
A bacterial culture was performed, and I was prescribed a seven-day course of saline nasal spray and a 14-day course of antihistamines.
The bacterial culture report indicated no growth of pathogens or normal upper respiratory tract microorganisms, suggesting the absence of bacteria.
I would like to ask why I continue to have yellow nasal discharge and nasal congestion despite the lack of bacteria.
Is it possible that this is odontogenic sinusitis, or could it be due to fungal sinusitis, a tumor, or other potential causes? Should I continue treatment with the dentist or the ENT specialist?
4.
Additionally, I have two swollen lymph nodes in the back of my neck, which the ENT clinic assessed as lymphadenopathy.
I would like to know if this is related to my sinusitis or if it could be due to other reasons.
Thank you, doctor.

Lily, 30~39 year old female. Ask Date: 2023/10/18

Dr. Zheng Jueyi reply Otolaryngology

Hello, it is recommended that if the yellow nasal discharge does not improve, you should continue to follow up with an otolaryngologist for examination, as it may be related to sinusitis.
The bacterial culture report shows "No growth of pathogens," which does not mean there is no bacterial infection; it simply indicates that no bacteria were cultured during the test, possibly due to prior antibiotic use.
As for the factors causing lymphadenopathy, there are many possibilities, and it is also advised to have them checked during your follow-up visit.

Reply Date: 2023/10/18

More Info

Understanding dental-related sinusitis is crucial, especially when symptoms overlap with dental issues. Based on your detailed history, it appears that you have experienced recurrent episodes of sinusitis, particularly following dental procedures. Here’s a comprehensive response to your questions:
1. Symptoms and Diagnosis: Your symptoms of facial pain, nasal discharge, and nasal congestion following dental work suggest a potential link between your dental health and sinus issues. Dental-related sinusitis, often referred to as odontogenic sinusitis, can occur when infections from the teeth, particularly the upper molars, spread to the maxillary sinus. This is particularly relevant in your case, as you had a history of dental issues and subsequent sinus symptoms after tooth extraction. The presence of yellow nasal discharge and nasal congestion, even in the absence of bacteria in cultures, can indicate inflammation rather than a bacterial infection. This inflammation can be due to various factors, including allergies, viral infections, or even fungal infections, particularly if you have a history of recurrent sinusitis.

2. Further Investigations: Given that your symptoms have persisted despite antibiotic treatment and that cultures showed no growth, it may be beneficial to consider further imaging studies, such as a CT scan of the sinuses. This can provide a clearer picture of any anatomical issues, such as a possible connection between the dental extraction site and the sinus cavity, or other abnormalities like mucosal thickening or polyps. Additionally, a referral to an ENT specialist for a thorough evaluation, including possible allergy testing, may be warranted.

3. Potential Causes: The absence of bacterial growth in your cultures does not rule out the possibility of odontogenic sinusitis. In fact, dental infections can sometimes lead to sinusitis without the presence of typical pathogens. Fungal sinusitis is another possibility, especially if you have had recurrent sinus issues. Tumors or other structural abnormalities in the sinus cavity could also contribute to your symptoms, although these are less common. It’s essential to follow up with both your dentist and ENT specialist to explore these possibilities further.

4. Lymphadenopathy: The swollen lymph nodes in your neck could be related to your sinus issues, especially if there is an ongoing inflammatory process. Lymph nodes often swell in response to infections or inflammation in nearby areas, including the sinuses and teeth. However, they can also be indicative of other conditions, so monitoring their size and any associated symptoms is important. If they persist or increase in size, further evaluation may be necessary.

In summary, your situation highlights the complex interplay between dental health and sinus issues. It is advisable to continue working closely with both your dentist and ENT specialist to address your symptoms comprehensively. They may recommend further imaging, allergy testing, or even a referral to an infectious disease specialist if necessary. Managing your sinus health may also involve addressing any underlying dental issues, so maintaining open communication with your healthcare providers is key.

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