Chronic Sinusitis infection cause asthma like symptoms?

[clpa07]

Hi,

Ive recently been going through an  illness for the last 2 months. Ive been out of work, school, and any social activities I hope I can get some insight on what is going on

It started when I was exercising about 2 months ago. I quickly stopped my run because i found myself oddly out of breath. Before this I was almost religiously in the gym 4 times a week. I have had problems with allergies in the past and I guess that it was prime allergy season in Arizona. However, I was never treated for allergies, it never bothered me. In fact, I went to an allergist and I was allergic to pretty much EVERYTHING airborne that was going on in arizona and some foods.

At first they though it was asthma. I was having problems breathing and severe chest pain so I was put on some inhalers. I didn't respond to that and weeks went by till I got a Sinus CT scan. The CT scan showed that my right maxillary sinus was completely opacified. I also was tested for Valley Fever which is very common in Arizona but it came back negative. I also went to 3 pulmonary doctors and only 1 said they thought it was asthma. I have no wheezing though just shortness of breath and congested. I am just fatigued, having a hard time concentrating and frequent headaches and congested with post nasal drip.

I guess the general question is: could a chronic sinus infection cause my symptoms of shortness of breath, chest pains, and of course congestion?  I don't know how it could be asthma considering Ive never had any problems like this before. I'm currently on antibiotic and anti histamines and its offered some relief yet i still have shortness of breath throughout the day. A month after the antibiotics I got a follow up CT scan of my sinuses and it showed no significant improvement and my Ear nose throat doctor is wanting to do surgery. If you have any insight i would appreciate it!

[National Jewish Health]

What you describe, an opacified maxillary sinus, is a potentially serious problem and will need to be addressed.  Sinusitis is probably the cause of your headaches and postnasal drip, but almost certainly not the cause of your shortness of breath, except to the extent that sinus disease can be causally related to asthma worsening, and it is definitely not the cause of your "severe chest pain."

The combination of shortness of breath, especially "throughout the day" , and "severe chest pain" is worrisome and raises consideration of more serious diseases such as recurrent pulmonary emboli, also called clots to the lungs, and pulmonary hypertension, either primary or secondary to emboli.  Pulmonary function tests (PFTs) could be helpful to the extent that it could rule out the diagnosis of asthma, but more to the suspicion of other disease would be an echocardiogram, a D-dimer determination and a CT scan of your lungs to rule-out pulmonary emboli and diffuse interstitial lung disease (ILD) that might not be apparent on plain chest x-rays.

You may well benefit from sinus surgery, but before agreeing to it, you should ask the ENT for his/her opinion of the significance of an opacified sinus, the procedure he/she recommends and the likely outcome of the surgery, such as benefits and untoward results.  If you are at all reluctant to proceed with major sinus surgery, you should request a second ENT opinion.  More importantly, you should proceed with further evaluation of your chest/lung problem, before scheduling the sinus surgery.  As a first step you should discuss this recommendation with the pulmonologist, in whom you have the most faith, and share this response with him.

You should not delay arranging for further evaluation.

[clpa07]

Thanks for your reply doctor. Not sure if you reply after an answer, but I forgot to mention that I did have an CT scan w/ contrast on my lungs prior to finding about the sinus infection. Maybe I should get another one. Anyways, it said that everything was normal and no convincing evidence of pulmonary embolism identified. Ive also been to the ER a couple times for being out of breath and gotten a D-dimer and came back negative. The scan, however, showed a 6mm nodule on the right lobe not clearly calcified and indeterminate. Also several other "faint areas of peripheal pleuroparenchymal nodularity" noted which said is was post inflammatory, hence the tests for valley fever. Also revealed fatty infiltration of liver. Other than that my pulmonary doctor said the scan looked fine. So i don't know if i just have inflammation going on my lungs from the sinus infection or what. And I did have a echocardiogram and EKG and my dr said those came out fine as well.

But I am going to get another CT of my chest before the surgery. And in your opinion, is the endoscopic surgery for the sinus' reliable? My ENT thought it was quite necessary since it didn't go away after being on antibiotics for a month. I was referred to this ENT from a different ENT doctor. I'm actually starting to use a neti pot and it seems to be helping a little bit when I'm not congested enough to use it. Thanks Doctor.

[andydandy]

I believe you must direct the second email as a question to receive a response from the Dr again.  

I have a friend who has opted out for sinus surgery.  She has had many sinus bouts but feels the odds that it will really help are not favorable.  She is working with other remedys for the present.  Is it really necessary after only one serious sinus infection?  Think about that.