History:
All through my childhood I had severe ear infections and was consistently on antibiotics until, at the age of sixteen, a tumor was discovered on my right eardrum (primary cholosteatoma). It was surgically removed at the University of Washington. Since then I have had no problems with ear infections. I have a suspicion though that the same thing which caused my ear problems had already moved into my sinuses. At about age 22, I began making regular visits to the doctor because of sinus infections. Amoxycillin was the drug of choice and I started a number of years being on and off antibiotics.
When I lived in Billings, Montana I was finally referred to an ENT, who told my I had nasal polyps and sinus disease. He prescribed Beconase and this did shrink these polyps for a while. But I still had chronic sinusitis and was always going back on antibiotics. At this point the antibiotics were becoming ineffective to get rid of the infections. I consulted another ENT who took cat scans and recommended surgery. I had the surgery (polypectomy, ethmoidectomy) in 1993, at age 30. The sinus infections began coming back only a few months later. In 1995 I consulted an internist who prescribed augmentin and flonase, which helped for about five months. I consulted another ENT, who did another cat scan and said the polyps were back, my sinus disease was worse and that I needed another surgery.
This time I decided that another expensive surgery that didn't provide any relief was out of the question. Antibiotics were negatively affecting my health in all sorts of ways. I have tried everything from saline lavage, herbs, saline nose sprays, hot showers, hot and cold compresses, humidifiers, you name it. The headaches are now becoming unbearable, the pressure being between my eyes, behind my cheeks, my forehead and at the base of my skull. I seldom have a "runny nose", but I do have constant (every minute of every day) post nasal drip down the back of my throat. I find it hard to think and feel generally awful most of the time.
Do you have any recommendations for my next course of action? I'm not looking for a cure at this point, only some relief from the pain and a way to avoid infection.
Thank you.
Reply: ---------------------------
The symptoms you have described are quite consistent with chronic sinusitis with sino-nasal polyposis. The management of this condition requires an attempt at identification and, if possible, removal of precipitating factors which may include allergy, environmental irritants, persistent bacterial (or occasionally fungal) infection, immune system compromise, and anatomic abnormalities. An allergy consultation may be appropriate at some point, but medical therapy for this type of problem generally requires a period of sustained antibiotic therapy (eg 4 or more weeks of daily antibiotic), mucolytic agents (guaifenesin) to thin thickened nasal and sinus secretions, and a period of sustained steroid therapy (eg daily use of topical nasal steroids, perhaps combined initially with a short period of systemic steroids). Proper humidification is appropriate particularly in cold weather months and I highly recommend pulsed nasal irrigation (eg with a "water-pik" and special nasal irrigation tip). Nasal irrigation is generally done with a saline solution, but in particularly refractory cases of chronic sinusitis, antibiotic solutions are frequently utilized.
Anatomic abnormalities which contribute to sinus obstruction and chronic sinus disease, often ultimately require surgery as part of the overall treatment scheme. It is important to recognize though that surgery by itself is not always capable of completely correcting the problem and continued chronic treatment measures may be necessary. Symptomatic nasal polyps are often best treated surgically via an approach known as endoscopic sinus surgery in which diseased tissue is removed while attempting to spare normal functioning sinus and nasal mucosa in a way that restores normal sinus drainage pathways. But again, it is important to note that unless chronic sinus problems can be entirely attributed to focal anatomic problems such as a deviated septum, congenital sinus blockage, etc., even successful surgery does not necessarily result in permanent cure of chronic or recurrent sinus disease without concurrent chronic non-surgical treatment measures such as continued maintenance usage of topical nasal steroids, allergy management, proper humidification, diet, etc.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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