Recurring acute sinusitis

[awtoner]

31 M non-smoker, history of nasal allergies, 2.5 years of recurrent acute sinusitis. 4 infections in 6 months, re-ocurring 2-4 weeks after finishing antibiotics.

Sore throat
Thick yellow post-nasal drip
Can’t irrigate maxillary sinuses with Sinus Rinse bottle (Usually it fills the sinuses then drains out when I tilt my head.)
Upper jaw tooth pain, headache
Painful sensation in bottom of maxillary sinus when trying to drain sinus rinse (before passage fully closes off, like trying to shake water out of ears)
Malaise, irritable
Change in voice and appetite
Sensitivity to noises, ringing in ears
Sometimes a low grade fever

Treatment: prednisone + Avelox and/or Vantin. Vantin alone cleared last infection. Two 4+ week antibiotic courses in 2007 and 2009. Symptoms clear quickly after starting antibiotic.

Persistent clicking/popping noises in both ears every time I swallow. No TMJ.

Ear tubes and removal of tonsils and adenoids when I was young.

Allergic to pollen and animals. Tested and started shots Mar 2008. Sinus CT scans (when healthy) show a slightly deviated septum, no air-fluid levels, some mucus and passage swelling, and a cyst/polyp in my left maxillary sinus.

Daily medicines:
Xyzal
Veramyst
Singulair
Multivitamin
HCTZ
Trying Sinupret+ since yesterday
Sinus Rinse bottle

Questions:
1. Mucus cultures taken by ENT show moraxella catarrhalis. I’ve read that m. catarrhalis colonizes children, and my problems started soon after having our first kid. Is there a connection? What can I do about it?
2. Should I get tested for food allergies?
3. Should I add anything to the Sinus Rinse bottle to prevent or stop infection? H2O2? Antiseptic? Xylitol? Plant extracts? Anti-fungal? Colloidal silver? Double salt packets?
4. Should I get a blood test for immune function? Stress hormones? CRP? Anything else?
6. I’ve also tried vitamin C, fish oil, and reducing alcohol and exercise. Anything else?
7. Should I try Sinus Dynamics before considering endoscopic sinus surgery?

[National Jewish Health]

You are probably correct, in the assumption that your symptoms are on the basis of chronic recurrent sinusitis.  You should check with your dentist, however, to be certain that the “upper jaw tooth pain” is not on the basis of dental disease.  The sinusitis could be infectious, allergic, a combination of the two or allergic to an infectious agent, a condition known as Allergic Fungal Sinusitis.  You should check with your doctor about this and request that fungal cultures of your sinuses be performed.  While some of your symptoms can be caused by tempero-mandibular  joint disease the “thick yellow post-nasal drip” is undeniable and almost certainly an indication of disease of  your nose and/or sinuses.  

M. catarrhalis is the third most common cause of sinusitis in adults and children after nontypeable H. influenzae and S. pneumoniae.  It is also a common cause of otitis media (middle ear infection) in children and children may indeed be carriers of this organism.  Many infections caused by M. catarrhalis can be treated with oral antibiotics. The following is a description of antibiotic therapy for this bacterium.  The organism is generally susceptible to amoxicillin-clavulanate, trimethoprim-sulfamethoxazole, tetracyclines, oral cephalosporins (e.g., cefixime, cefpodoxime, cefaclor, loracarbef, cefuroxime), macrolides (e.g., azithromycin, clarithromycin), and fluoroquinolones M. catarrhalis is also uniformly susceptible to ticarcillin, piperacillin, second- and third-generation cephalosporins, and aminoglycosides. M. catarrhalis is resistant to penicillin, ampicillin, vancomycin, and clindamycin.

Questions:
1. Mucus cultures taken by ENT show moraxella catarrhalis. I’ve read that m. catarrhalis colonizes children, and my problems started soon after having our first kid. Is there a connection? What can I do about it?  

You may require long term therapy to eradicate Moraxella, especially with the continuous exposure to your young children.  You should discuss the management of Moraxella with your doctor or with an Infectious Disease Specialist.


2. Should I get tested for food allergies?  

Food allergy testing would probably not be helpful;  a waste of time and money.




3. Should I add anything to the Sinus Rinse bottle to prevent or stop infection? H2O2? Antiseptic? Xylitol? Plant extracts? Anti-fungal? Colloidal silver? Double salt packets?  

You would do well to discuss this with your doctor and, especially, with your pharmacist.  The latter may be the best source of information.


4. Should I get a blood test for immune function? Stress hormones? CRP? Anything else?  

Your doctor may want to check your immunoglobulins as serum IgA deficiency can predispose one to chronic sinus infectious disease.


6. I’ve also tried vitamin C, fish oil, and reducing alcohol and exercise. Anything else?  

No.


7. Should I try Sinus Dynamics before considering endoscopic sinus surgery?  

Sorry, but I am unfamiliar with “sinus dynamics”.



Finally, I suggest that you request a second ENT opinion and do not consent to sinus surgery, until you do get the 2nd opinion.  You should ask your doctors about the likelihood of success of any and all contemplated surgery.

Good luck

[robert561]

A related discussion, Importance of food allergy testing was started.

[awtoner]

Thanks for the answer.

I visited my dentist just about 2 weeks ago and reported the sinus and tooth pain problems. He checked the x-ray, teeth, and gums and found no issues. The tooth pain tracks the yellow mucus. Thanks for the suggestion.

Sinus Dynamics is an inhaled anti-inflammatory, antibiotic, antifungal. I found it on a web search. I'm just looking to avoid surgery if at all possible, and concerned that even if I had surgery the underlying inflammation and infection will still persist.

Are you concerned by the benzalkonium chloride in Veramyst and the Astelin or Patanase I sometimes use? I've read that this preservative can slow cillia from clearing the sinuses, but it seems like a stretch for that to cause inflammation.

Could the Veramyst be decreasing my local immune response and making it harder to fight off infecetions?