Frustrated Re-current Sinus Infections for almost a year!

[lalove]

My husband has had chronic sinusitis (it tends to occur sec. to colds/or exercise-induced asthma).  Never drainage/congestion/fever. Only symptom is "pressure" mid-forehead & eyes. He's been on numerous abx/steroids beg. Oct/08; 8 courses of abx & medrol dose packs/pred. In order, he took Amox, Z-pack, Bactrim, Ceftin, Cefadroxil, and now Augmentin.  CT scan showed anatomically smaller left maxillary sinus, slightly dev. septum & some swelling (ENT couldn't discern if inflammation or infection).  He's taken longer, 4-6 weeks courses of Bactrim (in past) & now Aug. These abx offered some relief, but never felt 100%.  Med dose packs & Pred helped briefly, but after weens off, pressure builds up again.  Tried sinus irrigations daily, allergy meds ( singulair, claritin, flonase, nasonex, allegra).  He does not think this is allergy-related (he never gets congestion, sneezing, post-nasal drip, ect.  Hx of exercised-induced asthma (no asthma problems otherwise). No sig. med hx. Alt. approaches tried(no help)

He's left the state to deduct any environmental allergies/causes.  He's now off of Aug & weening off Pred as he's not cont. to feel improvement & trying to build his immune system back up.  He's on probiotics. Don't want to continue with abx & steroids as we are concerned about the negative consequences of long-term use (but don't want this to get worse & cause complications such as meningitis)

Questions:

Can chronic sinus infections ever get better without taking antibiotic/steroids?

Do some steroids work better than others- (ex- Pred/Medrol doesn't seem to work- any benefit to trying decadron)?

What is likelihood of anerobic, MRSA, or fungal infections?

Could long-term use of abx with steroids cause yeast overgrowth in sinuses?

If fungal in nature- would something like Diflucan help empirically?

He's a student with very poor insurance & surgery is the last resort (as we have read multiple times people's problems often persist?)

Thanks

[lalove]

Why would he then get this pressure following a cold or asthma & feel some improvement with use of antibiotics?  Soon after he's off antibiotics, he feels worse!

[National Jewish Health]

You and your husband’s doctors might want to consider the possibility that your husband either does not have chronic sinusitis or that he might have mild sinusitis that is not the cause of the “pressure, mid-forehead and eyes.”  With “never drainage/congestion/fever” and “never gets congestion, sneezing, post-nasal drip, etc” and a borderline normal CT scan, the evidence for chronic sinusitis is scant.     The  American Academy of Otolaryngology (ENT) classifies sinus symptoms as follows:  Major:  Facial pressure, congestion, nasal obstruction, a runny nose and a reduced sense of smell.  And, Minor:  Headache, fever, halitosis, fatigue, dental pain, cough and ear pain.  Headache, while not uncommon is classified as Minor only because it is a relatively insensitive and non-specific symptom, not because it is unimportant to the patient.  

Note how few of the above symptoms your husband has experienced.   There is evidence, in recent years, to suggest that many headaches or “pressure” attributed to chronic sinusitis are not really caused by acute or chronic sinusitis. It has been demonstrated that a majority of “sinus headaches” my really be Migraine headaches.   See the following abstract of an article published by physicians at the Cleveland Nasal-Sinus & Sleep Center, in Cleveland, Ohio..  I have highlighted the portions I deem to be most relevant.  You may want to pursue this possibility and share this message, not only with his current doctors, but also with a headache specialist.  You may also want to contact one of the investigators of the abstracted study, below, who may be able to put you in touch with a headache/head pressure specialist in your area.

Good luck,


ABSTRACT:
Authors Full Name: Levine, Howard L. Setzen, Michael. Cady, Roger K. Dodick, David W. Schreiber, Curtis P. Eross, Eric J. Blumenthal, Harvey J. Lumry, William R. Berman, Gary D. Durham, Paul L.


Institution: Cleveland Nasal-Sinus & Sleep Center, Cleveland, Ohio, USA.


Title: An otolaryngology, neurology, allergy, and primary care consensus on diagnosis and treatment of sinus headache. [42 refs]
SourceOtolaryngology - Head & Neck Surgery. 134(3):516-23, 2006 Mar.


While "sinus" headache is a widely accepted clinical diagnosis, many medical specialists consider it to be an uncommon cause of recurrent headaches. Unnecessary diagnostic studies, surgical interventions, and medical treatments are often the result of the inappropriate diagnosis of sinus headache. Both the International Headache Society and the American Academy of Otolaryngology-Head and Neck Surgery have attempted to characterize conditions leading to headaches of rhinogenic (nasal) origin. However, they have done so from different perspectives and in isolation from the other specialty groups. An interdisciplinary ad hoc committee recently convened to discuss the role of sinus disease and the nose in the etiology of headache and to review recent epidemiologic studies suggesting that sinus headache (headache of rhinogenic origin) and migraine are frequently confused with one another. Clinical trial data are presented which clearly indicate that the majority of sinus headaches can actually be classified as migraines. This committee reviewed scientific evidence available from multiple disciplines and concludes that considerable research and clinical study are needed to further understand and explain the role of nasal pathology and autonomic activation in migraine and headaches of rhinogenic origin. However, there was a consensus from this group that greater diagnostic and therapeutic attention needs to be given to patients complaining of sinus headache that may indeed be due to the nose. [References: 42]


Publication Type: Consensus Development Conference. Journal Article.