I have been a sufferer of chronic sinusitis, dust, dustmite and mold allergies (including asthma) for years. THis year, however, the symptoms have lingered much longer than usual and have not been responding to RhinoCort and SeldaneD treatments. Also, I've had constant drainage of bloody mucous for the past few months, as well as chronic fatigue and severe headaches and nosebleeds. Any suggestions for relief?
Reply --------------------------
The symptoms you describe are consistent with a diagnosis of chronic sinusitis. While nasal steroids such as Rhinocort and decongestants are commonly used in the treatment of chronic sinusitis, antibiotics are usually necessary and may be needed for extended periods of time (4-6 weeks of continuous treatment). Seldane D is an antihistamine-decongestant combination. The antihistamine component in some situations can be a detriment to the effective treatment of chronic sinusitis since antihistamines can impair sinus drainage by virtue of their tendency to dry up secretions.
The symptoms of bloody nasal or sinus discharge, headaches, and fatigue are very common symptoms seen in chronic sinusitis. I would recommend an exam by an ears, nose, and throat specialist since your symptoms have been of chronic nature. Most likely long-term antibiotics will be recommended combined with continued use of a nasal steroid and the addition of a medication known as a mucolytic - guaifenesin, Fenesin, or Humibid - which work to thin mucous secretions thereby promoting drainage. Increase in fluid intake and nasal saline irrigations are also frequently quite helpful. Often systemic steroids such as prednisone are also occasionally helpful. If symptoms persist beyond 3-6 weeks despite continuous therapy as described above, I then will typically recommend a CT scan of the sinuses which is a form of an x-ray. If significant sinus disease is seen on the x-ray at this point, it usually indicates the presence of persistent and resistant infection or irreversibly diseased lining of the sinuses. In either case surgery is often required then to eradicate the problem - contemporary sinus surgery involves the use of small telescopes or endoscopes with the intent of surgery being to open the natural drainage pathways of the sinuses.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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