patient is 19 yrs. old, diagnosed with chronic sinusitis which does not respond to any meds tried (currently on Zyrtec and Nasocort). Also is ANA+ 1:1280 which has not been diagnosed as anything as of yet. Also has celiac disease. Was in ER yesterday with chills, low grade fever (had for weeks), COUGH (had for weeks). Chest x-ray ok. Told to take Biaxin (2 500mg pills once a day for 3 weeks), along Prednisone Pack, and an inhaler
CT Scan results:
1. Small focus of soft tissue density at the anterior left ethmoid sinus.
2. Mild mucosal thickening at the inferior left maxillary sinus and minimal degree of mucosal thickening of the superomedial left maxillary sinus. There is a tiny focus within the anterior right sphenoid sinus and the posteromedial left frontal sinus.
3. Asymmetric enlargement of the inferior left nasal turbinate. There is a left concha bullosa. There is mild septal deviation towards the right.
Where do we go from here to get some relief? She is in college and struggling. Has had round after round of anitibiotics and various sinus medicines with little relief.
This young woman clearly has acute and chronic sinusitis. It is hard to imagine that she would be able to engage in college level studies with this chronic sinusitis. The poor response, or even lack of response, to antibiotics is telling. It suggests that the sinusitis may due to anaerobic bacterial infection or to fungal infection. The sinusitis could also be non-infectious and granulomatous, with or without evidence of vasculitis.
Anaerobic and fungal cultures of sinus drainage should be performed by an ENT specialist and consideration given to biopsy of sinus mucosa and, if feasible, biopsy of the "focus of soft tissue density at the anterior left ethmoid sinus."
I was going through antibiotics like water for chronic sinusitus. I had a deviated septum and a very narrow nose. I found a wonderful and gentle ENT and got the surgery for it last August. It has been wonderful! I have not had any significant illness since then (aside from a bout with a winter stomach bug and severe asthma). It was getting to where antibiotics weren't working at all. Now, I no longer require them. If I feel something coming on now, some supplements and a bit of extra sleep will fight it off. I can't recommend it highly enough!
At first, the doctor did not recommend surgery because my CAT scan did not show significant abnormalities. When it got to where I couldn't even work until 5:00 pm and antibiotics were ineffective, he decided to do the surgery. Sometimes, a CAT scan just doesn't tell the whole story.
The horror stories about sinus surgery are, for the most part, from the old days. Mine was a very healing experience. The pain, what little there was, was well managed by the medication. I was back to work in four days and off of the medication in one week. No more chronic fatigue! No more catching a cold just because someone drove down the highway!
Make sure you find a good doctor and surgical team. Kudos to my ENT and his group!
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