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Q. Do I need surgery for chronic sinusitis again as my symptoms are worsening?

Answered by
Dr. B. Vageesh Padiyar
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Feb 10, 2022

Hello doctor,

I have been experiencing chronic sinusitis for over six months now. The most prominent symptom is postnasal drip. I was diagnosed with allergies and secondary bacterial infection and had undergone endoscopic surgery a few weeks ago. Post-surgery, I was advised to take a five-day course of tablet Ciprofloxacin for the secondary bacterial infection (Pseudomonas aeruginosa). I noticed some improvement after the surgery and while I took the antibiotics. I am experiencing worsening of my symptoms again. Please help!

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Hello,

Welcome to icliniq.com.

The most common reason for your symptoms is severe allergic rhinitis with associated sinusitis. Before I suggest the treatment, I will try to explain the cascade of events in a very simple manner below, even though it is not as simple as it looks.

Exposure to dust or any hypersensitive substance will initiate sneezing or coughing to remove the offending agent. The throat initially reacts by activating cough impulses to push out the mucus. If this fails, mucosal cells in the nose start to hyperfunction, producing mucus to trap the dust. The mucus is blown from the nose or gets pushed into the throat due to mucociliary activity, thus entering into a new zone; if it does not happen, then a local inflammation around the throat starts causing symptoms such as a feeling of a lump in the throat and repeated feeling to clear the throat.

Chronic inflammation around the nose leads to involvement of the eustachian tubes, which ventilate air and equalize pressure between the nose and the ear. Inflammed lines do not function well, leading to a resultant negative pressure in the ear, causing ringing sensations, muffled noise, and sometimes decreased hearing. Long-standing inflammation in the nose also blocks the sinuses' outflow tract, leading to collected secretions, which accumulate infected and cause a pressure headache around your eyes, forehead, and cheeks. Your glands also get swollen for the same reason.

I know the problem has been there for a long time. Still, I am unsure if you have followed any specific treatment chart, usually recommended before considering any patient for surgery. This treatment chart is custom-made according to your symptoms and follows the guidelines to treat both allergies with sinusitis.

I advise you to follow the instructions:

1. Wear an N95 mask at all times, do not allow any dust or irritative substance from entering your nose. It is the most important thing you should be the following failing which, no treatment will bring any relief.

2. Tablet Sinarest (Acetaminophen, Chlorpheniramine, and Pseudoephedrine) - one tablet two times a day after food 12 hrs apart for 15 days.

3. Tablet Allegra-M (Montelukast and Fexofenadine) - one tablet two times a day after food for fifteen days.

4. Tablet Zerodol TH 4 mg (Aceclofenac and Thiocolchicoside) - one tablet two times a day after food for five days.

5. Tablet Clarithromycin 500 mg - one tablet two times a day after food for fifteen days.

6. Duonase nasal spray (Fluticasone Propionate and Azelastine) - twice daily in both nostrils for three months (do not inhale while you spray the drug).

7. Tablet Mucomix 600 mg (Acetylcysteine) - one tablet two times a day after food for one week.

8. Tablet Wysolone 10 mg (Prednisolone) - after breakfast for one week.

9. Steam inhalations three to four times a day.

10. Saltwater gargles - atleast eight to ten times a day for one month.

11. Do not smoke or consume alcohol as it slows down mucociliary clearance mechanisms.

All precautionary measures have to be followed strictly for maximum relief; otherwise, medications will not be helpful in the long term.

Surgery can be considered if the above medications and preventive measures do not give any relief. Ideally speaking in a nutshell, I again emphasize preventing any irritative substance from entering the nose and throat, thereby triggering an allergic cascade of events and reproducing the symptoms you have mentioned above.

It would help if you did not worry about anything; once you start following the abovementioned advice, your symptoms should start coming down, and I am sure you will recover with time.

I hope I have answered your query in detail. If there is anything more you need to know or enquire, you can contact us at icliniq.com.


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