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Doctors' Answers to "Frequently Asked Questions" - Sinus Problems


These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 11/17/1999]
Question: i have been taking amoxicillin three times a day for 5 days for the sinus infection. i wonder if i can discontinue the prescription since no running nose and fever anymore. Even there is little uncomfortable feeling (pain) around the sinus area especiallly during walking, i am preganent and do not want to expose to too many chemicals althought amoxicillin is safe. The only concern i have is that the sinus infection may be back if i stop the medication in the middle. Is it wiser to continue the medicine until ten-day course or stop right now?

Answer: This would depend on whether you had a fluid level in your sinus. But, usually we need an x-ray to decide this and probably not done with your pregnancy. Transillumination with a special light might help. 50-50 call.

[posted 08/26/1999]
Question: CAN DIFLUCAN WORK ON CRONIC SINUS INFECTION. I HAVE A FRIEND WHO SAYS IT IS THE ONLY THING THAT WORKS FOR HER.

Answer: If it is a fungal infection, possible but uncommon.

The Weather &  Sinus Headaches  [posted 11/24/98]
Question: Can sinus headaches be triggered by a change in weather? I only get sinus headaches within 12 of a rain storm, and my husband tells me I'm crazy. Am I? 

Answer:  Often, however, these "sinus" headaches are probably migraine variants. 

Should I have a CAT Scan for Sinus Problems? [posted 10/9/98]
Question:  I have suffered from sinus problems for several years, but they seem to be somewhat atypical in comparison with others who suffer the same problems. I experience sinus pressure in varying degrees daily along with uneven pressure, clogging and popping in the ears, but never have accompanying runny nose, watery eyes, etc. I recently visited an ENT and was placed on Levaquin and Exgest which did not help. He then placed me on Cedax, Claritin and Rhinocort, but still to no avail. After three weeks of treatment, he's ready to perform costly CT scans and recommending surgery. Should I pursue another course of treatment such as seeing an allergist? Also, I have recently experienced an irritation and blurred vision in my right eye. My opthamologist doesn't find an infection, so I'm wondering if any of these medications can cause problems with the eyes. The insert that came with my Rhinocort Rx said that it may cause intraocular pressure. I've experienced pressure with blurred vision and burning.

Answer: Doubt it is the Rhinocort,but, I agree with the ENT about the CT scans.

Can Sinus Infections be Transmitted? [posted 10/8/98]
Question:I have had a nasal lining ,yellow crusting since 1988; developing into clear drip,sore throat, 2 yyears in duration. It is now a family problem: my husband,daughter and son; we have noticed how easily others in room sneeze when in our presence and pick up the same symptoms. it has lead to severe sore throats,headaches,ear aches, eye twitching,extreme fatigue. We have had unsuccessful diagnosis by doctors and several specialists. The most common conclusion was allergies,however this was eventually ruled out by an allergy specialist who suggested an infection of some kind.

Answer: Did the allergist treat you with antibiotics? If not I would, but, I doubt that this would be transmitted to your family-most nasal/sinus infections are not transmitted.

Sinus: Strange Smell [posted 10/1/98]
Question:I have a very strange problem in my sinuses and I have gone to see 3 specialists and they have no idea what it is, i get this weird smell in my nose and I have had it for 4-5 years now and it is driving me crazy. My Doctor keeps prescribing me antibiotics and they don't help. To get rid of I have to bend my head down and hold my breath until my sinuses fill back up again. So can you please help me ?

Answer: Has there ever been an abnormal x-ray of your sinus? This sounds like an anerobic infection of the sinus. This would call for surgery if the antibiotics are not clearing it;but, I don't hear that the diagnosis of sinusitus is very firm. Maybe see an ENT specialist.

Sinus Infection Medication [posted 8/7/98]
Question: I have been on Bactrim DS for a 10 day cycle and then after 5 days, I have the symptoms back. The doctor put me back on the same treatment for another 10 day cycle. It doesn't appear to be working and causes an upset stomach despite the fact that I take it with food and lots of water. Is there another course of treatment that you would recommend?

Answer: Any of the cephalosporin drugs or the macroglides (erythromycin, Biaxin, Zithromax,) would be a good pick.

Sinus Infection [posted 8/7/98]
Question: About 3 and 1/2 months ago I went to a doctor about what I suspected was a sinus infection. I've had them before and had been congested for a while when I noticed discolored mucus. The doctor prescribed Bactrim, which I took for about a week, and three days after the prescription ran out I had what I thought was a severe allergic reaction. I had enormous hives all over my body which began to coalesce into welts. I went to the doctor again, he prescribed Allegra, which kept it at bay for about 3 hours at which point, even after taking another dose, it became much worse and I began to have tightness in my throat, my voice became lower and I had difficulty swallowing. I went to the emergency room, was given a shot of Benadryl, prednisone, and was told to keep taking the Allegra. The next morning the welts were back on my legs, I went to the doctor again and he added Zantac to the regimen and prescribed an epipen and referred me to an allergist. I've had hives similar to this twice before, once after taking codeine and once while I had a cold that developed into a sinus infection. They've never been as bad as this particular episode. I went to the allergist (who said an epipen was probably a bit extreme) and had skin tests (a month later after being off all the above medications) and turned out not to be allergic to any of the 80 or so things he tested for, at least not enough to cause the reaction I had. He said the whole ordeal might have been caused by the sinus infection which had probably not been cured. He x-rayed my head and found no problem and told me to have a CT scan (which I have still not done due to insurance problems). He also prescribed Rhinocort, which I used for a month or so until it ran out. Last week I got the flu (I think) and had to fly somewhere. The flight was one of the most painful experiences I have ever had, and afterwards my congestion was much worse. When my congestion didn't clear up after the return flight, I went to the doctor again. He prescribed another nasal steroid (Nasanol, I think). He tapped on my head and said that because that didn't cause me pain, the infection would probably resolve itself just fine. Aside from the allergist, all the doctors I visited were at my school's health center, and I was given no explanation of any possible side effects or things I should avoid while on the various medications. (They were all either physician samples or dispensed in unlabeled pouches) What are the side effects of nasal steroids and bactrim? Is there anything I should have avoided while on the bactrim? Should I have the CT scan, or was the doctor correct that the infection will probably resolve itself? I've been congested on and off for years and have always had trouble with headaches and clogged ears. I've been very fatigued lately, and more or less constantly have to go to the bathroom, could there be something else going on other than the sinus infection?

Answer: I suspect the allergic problem was to the Bactrim - probably the sulfa part of the drug. Avoid any further sulfa based drugs. Secondly, it sounds like the sinus infection was never cleared up. This will probably need further antibiotics - sinus infections are always hard to clear and often take 3-4 weeks of antibiotics. However, sometimes it will not clear due to difficulty draining the sinus - this is the purpose of the nasal steroids. Nasal steroids are almost free of side effects. Theoretically, you can get some systemic effects, but they are very rare. With the increased urination, I'd get your sugar checked, cheap test.

Sinusitis [posted 7/31/98]
Question: My 7 year old son has a chronic stuffy nose. He blows his nose many times during the day with thick mucus - light to medium yellow coming out. His pediatrician recommended that we see an allergist and we did. He is allergic to grasses and peanuts. I've kept up with pollen reports and for several months, the grass pollen has been almost non-existent. I have taken him to his pediatrician and she has put him on 30 days of an antibiotic. There was some improvement, but he still had some stuffiness. He has asthma, too. It is controlled well by beclovent and ventalen. He takes becanese and rhinocort (liquid), but this doesn't seem to help much. I am undecided what to do. Should I take him back to the allergist or see an ENT specialist? He gets very frustrated about having to blow so much and he seems to be sounding more nasal as he talks. What are your suggestions?

Answer: A fairly common problem and there aren't many great answers unless he responds to the shots of the allergist. If he has a chronic sinus infection, these rarely get better. I would ensure that he has had sinus x-rays and possibly a CT of the sinuses. Give the shots time, they really are the only major hope of eliminating this problem.

Sinusitis and Allergies
Question: I have been suffering from upper respiratory infections since September 1996 and have been treated at least once or twice a month (one month 3 times) with different antibiotics (500 to 875 mg each normally twice a day) and decongestants. My doctor has changed my allergy medicine from Seldane to Allegra(2 times daily) because of the interactions it has, and I'm also on nasal inhaler, ProventilHFA inhaler, 875 mg Antibiotic(2 times daily), and a decongestant(2 times daily). I am supposed to take the antibiotic and decongestant for 30 days. If it isn't cleared up, they want to do sinus surgery. I feel like they should send me to an allergist before doing surgery. I think that should be a last resort. Please advise as to your opinion on this situation.

Answer: Recurrent sinus infections often require surgery as a fix. This is because the inflammation of the early infections damage the small drainage hole in the sinus leading to further infections. The surgery is aimed at restoring drainage which will decrease or eliminate the sinus infections. If the fluid is merely from allergies and not infected then an allergist may help. If the fluids are infected, then an allergist is unlikely to help. However, no one wants sinus surgery and it probably wouldn't do any harm to try this approach.

Sinus Infection
Question: I am a 49 year old male and I have had allergy problems and sinus problems all my life. Approximately 6 weeks ago I came down with what I thought was a sinus infection. I had drainage, stuffed up nose, etc. I am being treated for allergies to dust, fescu grass, and cotton wood. I have had this drainage and sickness for over 6 weeks and nothing seems to cure it. I then saw an allergist and got a sinus cocktale shot to no avail. I then got another sinus cocktale and penicillin shot (10 day strength) with no improvement yet again. I then got vantin 100 mg and rynatus with no improvement. When I went back to the doctor I got a chest x-ray. It showed some signs of bronchitis. I then went on biaxin 500 mg, syn-rx tablets and vanex grape for a cough. I showed no real signs of improvement. The next week I went to allergist and a head x-ray, which showed no problem with my sinuses. He sent me for a catscan and it showed infected tissue lining the walls of my sinuses. He treated me with clyndamycin, 10 days of prednisone, and duratus. There was some improvement, but I was still not well. This has been going on for about 6 weeks.

Answer: It sounds like you have a chronic sinus infection. This entails 4-6 weeks of antibiotic treatment and occasionally will need surgery to correct. These are difficult to treat once established. By the way, almost no physicians give shots in their office since the duration is short and oral antibiotics will achieve the same or higher serum levels for this type of infection.

Sinus Infections
Question: For several years I have had multiple yearly cases of Sinusitis. Throughout this time my sinuses have seemingly built up a congealed mass of mucus. By this I mean this glob moves from one side off my head to the other, with the angle of my head. I have tried many over-the-counter and prescribed medications, with no effect. During this time I have experienced many ear infections, reduced hearing and ringing in the ears. Would evacuation of the sinuses have any long term effects? If not what can I do or recommend to the ENT to eliminate this problem?

Answer: Recurrent sinus infections often result in surgery in an attempt to decrease the number of infections. A CT of the sinuses may be helpful in deciding this issue. If your ENT has never considered the possibility, I would get a second opinion.

Sinus Drainage
Question: In 1983 I inhaled what I thought was coke, and in fact, was something far worse. What ever it was did damage to my sinus in the right nostril. To this day the right side drains constantly, causing me to blow my nose several times and hour. Is there a surgery or something that I can do to stop this problem?

Answer: You’ll need to see a physician to see if there is a perforation in the septum dividing your right from your left side of your nose. This is usually fixable.

Sinusitis
Question: What is the connection between thyroid hormones and sinusitis? My most recent thyroid tests indicate that I am borderline hypothyroid. I am currently not receiving any medication for my condition, but I am plagued with chronic sinusitis. I have had two surgeries for correction of a deviated septum along with correction of turbinates (and all that goes with it). However, I am now told that my septum has once again becomed deviated. Is this a common occurance? When I had my last sinus surgery (January 1995) my Otolaryngologist had to remove a large amount of fungus from my sinuses. How common is that? Is there any way to prevent its return? My symptoms are identical to the symptoms I had two years ago: heaviness in my sinuses and infections that are not responding to antibiotics (amoxicillan and biaxin).

Answer: Chronic sinusitus can be caused by many different etiologies - I'm not aware of thyroid disease being one of them. In general, the sinuses drain from very small holes and any blockage or difficulty draining sets one up for chronic sinus infections. Like most parts of the body, the lack of drainage gives bacteria and fungal agents a perfect growing environment. Fungal infections are an uncommon cause of fungal problems. They typically occur in diabetics and in people with impaired immunity. Treatment is usually medical, and not surgical, although removal of large fungal masses is sometimes necessary. Use of normal antibiotics is completely ineffective against most fungal agents, with Nocardia being the exception. If you really have a fungal infection of the sinuses, I would consult an Internist or Infectious Disease Specialist.

Chronic Infection
Question: I have been having a 5 week problem with my sinuses. The problem only seems to be getting stranger. The odd part is that when I am sitting or standing still my sinuses will completely close and I must breath through my mouth. If I walk, dance or otherwise become physicaly active, I open up completely and can breathe normaly. This includes being exposed to smoke at night clubs. When driving my car, my sinuses will close, but when I get out to walk into a store, they open in the time it takes to get to the door. I saw a doctor at a small clinic and he said he had never heard of this particular problem. Can this possibly lead me to the root of my sinus problem. I keep feeling as though this thing will not end.

Answer:I thought about your problem for a while and I really have no great ideas that would help you. I'd contact an ENT specialist and get a CT of the sinuses.

Septra
Question: Started taking Septra DS for Sinus infection. Developed chest compression symptoms accompanied by muscle weakness within 24 hours. Developed fever within 48 hours. Are these signs of an allergic reaction to Septra. Took sulfa drugs once before five-six years ago. Non-HIV patient.

Answer:Possibly; but, hard to know if it was the infection for which you started Septra DS.

Prednizone
Question: Why would a doctor order Prednizone (nasacort spray) for a 5 yr. old with a simple sinus infection? Is it FDA recommended for a 5 yr. old? Why would ANY 5 yr. old be given prednizone?

Answer: Intranasal steroids have a completely different side effect profile than oral or systemic steroids. Unless used in excess and for long periods of time there appears to be no side effects(as opposed to systemic steroids). It is a little like using steroid cream on the skin; but, even less side effects. Recurrent sinus infections are however a problem and many physicians treat nasal infections with steroids to reduce the swelling around the "drains" from your sinuses to the nose. This is to reduce recurrent sinus infections and reduce the risk of long term surgery to correct the problem. Given the risk/benefit ratio most physicians use the steroids.

Bactrim and Alcohol
Question: What, if any, are the adverse and/or side effects if while taking Bactrim DS for a sinus infection and having the occasional beer/mixed adult beverage???

Answer: Very few if it is only occasional.



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