I still get some sinusitis after FESS and septoplasty. Why?

Question

Hello doctor,

I have a history of sinusitis. Last year, I had chronic sinus symptoms and got a CT scan. It showed nasal septum deviation and blocked maxillary and frontal sinusitis due to nasal polyps. I got a FESS and septoplasty done. This year, the symptoms reappeared strongly. I have severe headaches, facial pressure, nasal discharge, and pain in my jaws and ears.

Along with that, I have a frequent infection in my sinuses and have done an antibiotic course four times in three months. I got a CT scan, and it shows complete opacification of the maxillary sinus, little ethmoid sinus, and hypertrophy of nasal turbinates. I am using Nasonex (steroid) spray twice a day and getting nasal rinses done repeatedly with saline water. I am taking steam and antihistamines before sleeping but not getting better.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I shall tweak your medicines a bit and let us see if that gets you an improvement. Change the antihistaminic to one with Montelukast. Say like Levocetirizine or Fexofenadine plus Montelukast 10 mg. Take this once daily. Take another antihistamine different from the above at a different time daily. That means you will be getting two antihistamines per day and one with montelukast combination. Take a short course of Deflazacort 6 mg twice daily.

Take the same for five days and taper it to once daily for the next five days. Use the Nasonex (Mometasone furoate) spray appropriately twice daily. There are particular instructions as to using the spray. It has to be held in a particular way and sprayed. If you have thick nasal discharge or fever or throat pain, it is prudent to add an antibiotic, preferably Clarithromycin 500 mg twice daily for five days.

Let us know the progress with these medicines. Please upload previous and current CT scan films to us when you write to us the next time.

Do provide all previous treatment records and medication details when you get back.