Dr. Sandeep Shrestha
Otolaryngology (E.N.T)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am a 29-year-old female and had eustachian tube dysfunction and chronic sinusitis (pressure on either side of my nose, congestion, brain fog, and headaches) for about eight months. I had allergy testing done which revealed allergies to mold and a few trees. I also had a CT scan which revealed inflamed maxillary sinuses and a deviated septum. I always had some trouble breathing through my nose, so I have a septoplasty scheduled after two months. However, I never had severe symptoms or ear blockages until the past year. Medications for allergy did not help, and decongestants gave me heart palpitations and shaky hands. I have tried Allegra, tablet Claritin, tablet Claritin-D, tablet Azelastine, tablet Flonase, tablet Hydroxyzine, tablet Amoxicillin, Augmentin, Prednisone, and tablet Singulair. In addition, I have tonic tensor tympani syndrome and episodes of muscle spasms in my ear whenever I hear a sharp sound like dishes being put away. It worsens when I have sinus or ear congestion flare-ups. In addition, I often suffer from insomnia and neck pain. All of these symptoms have caused great fatigue and anxiety and impacted my ability to enjoy life. I have a mold expert coming to my home to test me. I have taken CT scan of sinuses and done allergy testing. No medication makes me feel better other than antibiotics, and I feel hopeless. Kindly help.
Hello,
Welcome to icliniq.com.
As per all your history and reports, it seems to be chronic rhinosinusitis with a deviated nasal septum to the left (attachments removed to protect patient's identity). As your symptoms are persistent in spite of all the medication, I feel surgery is the treatment option for you. Now I suggest you the following medications; 1) Tablet Amoxycillin 500 mg three times a day for seven days. 2) Tablet Paracetamol 500 mg three times a day for five days. 3) Tablet Chlorzoxazone 500 mg one tablet three times a day for five days (it will help your neck pain and spasm). 4) Nasal drop Oxymetazoline 0.05% three drops three times a day for seven days. 5) Nasal spray Flonase (Fluticasone propionate) one puff two times a day for one month. 6) Tablet Levocetirizine 5 mg one tablet night for two weeks. 7) Tablet Montelukast 10 mg once at night for two weeks. Take steam inhalation twice a day. Do nasal wash using warm salt water using neti pot two times a day; it will help you. I hope you find the reply useful. Thank you.
Patient's Query
Hi doctor,
Thank you for the reply. Are you recommending taking all these medications or to choose between them? Are they in any specific order? Many of them are prescription medications. My ENT told me that I did not need Amoxicillin because I did not have an active sinus infection when the CT scan was taken, but my symptoms have flared up since then. Should I consult again? Out of these medications, I am currently taking Paracetamol, Oxymetazoline, Montelukast, and Flonase (which gives me anxiety and heart palpitations). I am taking Montelukast in the morning, and it takes a while for it to act, and it only lasts for a few hours. Should I take it at night? I forgot to mention that I am doing neti pots daily, but my nose has been so clogged that I cannot even get the water to go through it, and it is causing sharp ear pain. Should I keep trying? Lastly, do you think the surgery will help with the eustachian tube dysfunction and ear muscle spasms? Thank you.
Hello,
Welcome back to icliniq.com.
All these medications are more effective in relieving your symptoms when combined. Each of them have a different role and is really effective when taken together. Yes, tablet Amoxicillin is for active infection, but as your symptoms have flared up, I suggest you take one week course. I have suggested you a combination of tablet Levocetirizine and tablet Montelukast as Levocetirizine is sedative and it is better to use at night. Neti pot is really helpful. Try using it by bending your head forward and slightly to left or right alternatively while breathing through the mouth. It is difficult for the first few days, and then you will feel good. It is better to use the water kept in a copper vessel for 12 to 24 hours. As your doctor has a plan for septoplasty, it is a procedure to make the septum straight. It can relieve your symptoms and can help your eustachian tube dysfunction to some extent. Regards.
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Otolaryngology (E.N.T)
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