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Respiratory Disorders (Expert Forum)
Chronic Sinus Infection Saga
Answered by
CO
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Chronic Sinus Infection Saga
by Claudi47, Jan 27, 2009 12:07PM
For about four years i have had chronic sinus infections. I have had two surgeries on my right sinuses and correction of a deviated septum. I have had three surgeries on my left sinuses, the last one being a caldwell-luc. None of these have helped. I was also diagnosed with eosinophillic pneumonia during this time which was brought into control with the use of high doses of prednisone. I have tried an endless array of medications and procedures to rid the infection. At one time MRSA was present in my sinuses but now seems to be gone. Now, pseudomonas has been found and my ENT has prescribed Fortaz in-home iv treatment for 30 days. Meanwhile, my lungs don't seem happy with daily use of Advair. While I have not given up on trying to find a cure, I feel like a ping-pong ball, am feeling fairly hopeless, and don't know where to turn next. I think the whole sinus/lung thing is connected but ENTs and pulmonists don't think so. Do you have any suggestions?
Doctor's Answer
by National Jewish Health, Jan 30, 2009 05:05PM
, Jan 30, 2009 05:05PM
Given that you have had eosinophilic pneumonia, it is conceivable that you might also have eosinophilic chronic rhinosinusitis a subcategory of which is allergic fungal sinusitis. It is also possible that your inflamed sinuses became vulnerable to infection and have become secondarily infected with methicillin-resistant staphylococcus aureus (MRSA) and Pseudomonas. You might want to ask your ENT if the surgical sinus specimens were sent to pathology and, if so, what did they show that might even hint at eosinophilic infiltration. You should also ask if material from your sinuses was ever cultured for fungi, the most common one in this circumstance being Aspergilla.
It is also worth noting that the sinus tissue IgE profile is more specific than the systemic profile in determining the allergic status of people with allergic fungal sinusitis.
It would also be important for your doctors to confirm that the eosinophilic pneumonitis remains controlled with the Advair® HFA (fluticasone propionate and salmeterol) Inhalation Aerosol and to advise them of what you describe as, “...my lungs don’t seem happy with daily use of Advair.”
It might be useful for you to seek consultation with a university hospital medical center immunologist to pursue the above possibility.
Good luck.
It is also worth noting that the sinus tissue IgE profile is more specific than the systemic profile in determining the allergic status of people with allergic fungal sinusitis.
It would also be important for your doctors to confirm that the eosinophilic pneumonitis remains controlled with the Advair® HFA (fluticasone propionate and salmeterol) Inhalation Aerosol and to advise them of what you describe as, “...my lungs don’t seem happy with daily use of Advair.”
It might be useful for you to seek consultation with a university hospital medical center immunologist to pursue the above possibility.
Good luck.
