Chronic Sinusitis Symptoms: Ear Pressure, Headaches, and Yellow Phlegm

Sinusitis issues

Hello, Doctor.
For about a year now, I have experienced occasional hearing loss in my eardrum, and loud sounds can be uncomfortable, similar to the sensation of being in the mountains.
I also have a feeling of pressure and pain in the upper part of my eyeball, with tightness and discomfort around my eyebrows and the bridge of my nose, along with intermittent headaches that extend from my eyebrows to the back of my head.
Recently, this has become particularly severe, lasting all day, and the headaches before sleep persist throughout the night.
While they are not excruciating, I often wake up in the middle of the night still in pain.
Typically, the pain eases when I first get up, but after about an hour of activity, it becomes noticeable again, leading me to want to close my eyes and rest (experiencing drowsiness and fatigue).
The symptoms fluctuate but do not completely disappear.
I have visited the hospital multiple times for consultations.
Tests have shown negative pressure in the eardrum and swelling in the sinuses.
An X-ray previously indicated no sinusitis, but during a recent skull X-ray (Water's view), mild sinusitis was noted, located between the eyes and nose, while the frontal sinus appeared normal.
Some deep yellow mucus was suctioned out, and there is also post-nasal drip of white mucus.
Generally, I do not sneeze much, and the yellow mucus is minimal, mostly resulting from post-nasal drip.
I expectorate phlegm a few times a day, often noticing it is yellow.
During the consultation process, the doctor prescribed antibiotics.
However, over the past year, I have taken several courses of different antibiotics, but I still frequently catch colds.
The antibiotics are very effective when I have a lot of yellow mucus during a cold, but once the cold resolves, I still have a small amount of yellow mucus that has not disappeared over the year.
Since the quantity is not significant, it is usually expelled with the phlegm.
I have also consulted a pulmonologist, and an X-ray showed that my lungs are fine.
The doctor mentioned that sometimes thick phlegm can appear yellow, but during multiple follow-ups, the doctor noted that there is still post-nasal drip of yellow mucus.
After several consultations, I have accumulated some knowledge; it seems that the eardrum issues, headaches, pressure and pain in the upper eyes, and persistent sinus swelling, along with the presence of yellow mucus (though in small amounts), and minimal sneezing and nasal discharge, do not appear to be typical sinusitis.
There is no diplopia, and both eyes experience pressure and discomfort, which does not seem indicative of a tumor (I have seen a neurologist and had an EEG).
The desire to close my eyes and rest (experiencing drowsiness and fatigue) is the most troubling issue, making it difficult for me to work.
I have reported all these symptoms to my attending physician, but there is still no solution.
I am unsure how to proceed with further examination or treatment.
Could this be caused by deep-seated sphenoid or ethmoid sinus issues?

Niming, 40~49 year old female. Ask Date: 2015/10/23

Dr. Zheng Jueyi reply Otolaryngology

Hello, if you still have issues with rhinitis, you may want to consult an otolaryngologist to determine whether long-term use of nasal sprays or nasal irrigation is necessary to improve chronic inflammation.
Additionally, for headaches or feelings of pressure, you could consult a neurologist to see if they are related to migraines or other tension-type headaches.
Wishing you peace and good health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2015/10/23

More Info

Chronic sinusitis can indeed lead to a variety of symptoms, including ear pressure, headaches, and the production of yellow phlegm. Your description of symptoms such as ear discomfort, pressure, and pain in the upper eye area, along with headaches that persist throughout the day, suggests that you may be experiencing complications related to your sinus condition.

Chronic sinusitis is characterized by inflammation of the sinuses that lasts for more than 12 weeks, and it can be caused by various factors, including allergies, infections, or structural issues within the nasal passages. The symptoms you are experiencing, such as ear pressure and headaches, are common in individuals with sinusitis due to the close anatomical relationship between the sinuses and the ears. The Eustachian tubes, which connect the middle ear to the back of the nose, can become blocked or inflamed due to sinus issues, leading to a sensation of fullness or pressure in the ears.

The yellow phlegm you mentioned is indicative of mucus production, which can occur when the sinuses are inflamed or infected. This mucus can drain down the back of the throat, leading to post-nasal drip, which may explain the sensation of phlegm in your throat and the need to clear it frequently. The presence of yellow mucus often suggests a bacterial infection, although it can also be seen in viral infections or allergic reactions.

Given that you have undergone multiple evaluations and treatments, including antibiotics, it is essential to consider a few additional points. First, the fact that you have experienced persistent symptoms despite treatment may indicate that the underlying cause of your sinusitis has not been adequately addressed. This could include structural issues, such as nasal polyps or a deviated septum, which can obstruct sinus drainage and contribute to chronic inflammation.

You mentioned that imaging studies, such as X-rays and CT scans, have shown mild sinusitis but no significant findings. However, it may be beneficial to pursue a more comprehensive evaluation, such as a CT scan of the sinuses, which can provide a clearer picture of any anatomical abnormalities or blockages that may be contributing to your symptoms. Additionally, an endoscopic examination by an ENT specialist can help visualize the nasal passages and sinuses directly, allowing for targeted treatment options.

In terms of management, if you have not already done so, consider discussing the possibility of using nasal corticosteroids or saline nasal irrigation to help reduce inflammation and promote sinus drainage. These treatments can be particularly effective in managing chronic sinusitis symptoms. Furthermore, if allergies are a contributing factor, allergy testing and subsequent management may also be beneficial.

Lastly, if your symptoms continue to be debilitating and significantly impact your quality of life, you may want to explore the option of surgical intervention, such as functional endoscopic sinus surgery (FESS), which can help improve sinus drainage and alleviate symptoms.

In summary, your symptoms of ear pressure, headaches, and yellow phlegm are consistent with chronic sinusitis. Given the persistence of your symptoms, further evaluation by an ENT specialist, including imaging and possibly endoscopy, may be warranted to identify any underlying issues. Additionally, exploring medical management options, including nasal corticosteroids and saline irrigation, may provide relief. If conservative measures fail, surgical options should be considered to improve your quality of life.

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