Q. I have severe sinus pain with deviated nasal septum and no medicine helped. Please help.

Answered by
Dr. B Vageesh Padiyar
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jul 05, 2020 and last reviewed on: Jul 28, 2020

Hello doctor,

I am suffering from deadly sinus pain found with deviated septum. No medicine is working. Quality of life has got compromised. Please help.



Welcome to icliniq.com.

There is absolutely nothing that you need to worry about. You are having a severe form of sinusitis which has probably happened secondary to allergic rhinitis. Before we jump to the treatment, I have tried 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 irritative substance that your body is hypersensitive to) will initially initiate reflexes such as sneezing to remove the offending agent out. If this fails, mucosal cells in your nose start to hyperfunction producing loads of mucus to trap dust (owing to its sticky nature). This mucus has nowhere to go other than either being blown out of the nose or gets pushed into the throat owing to mucociliary activity thereby entering into a new zone. The throat initially reacts by activating cough impulses to push out the mucus, but if that fails, a local inflammation around the throat starts which often leads to symptoms such as a feeling of a lump in the throat and repeated feeling to clear the throat.

A chronic long-standing inflammation around the nose leads to involvement of the eustachian tubes which basically ventilate air and equalize pressure between the nose and the ear. Inflammed tubes do not function well and this leads to a resultant negative pressure in the ear causing ringing sensations, muffled noise, and sometimes decreased hearing as well.

Long-standing inflammation in the nose also blocks the outflow tract of the sinuses leading to secretions getting collected which then get infected and cause a pressure headache around your eyes, forehead, and cheeks. Even though your CT (computed tomography) scan shows very subtle edema in the sinuses, the pressure and pain could be much more and can also be related to a migraine.

I know the problem is there for a long time may, but I am not sure if you have followed any specific treatment chart which is usually recommended before we consider any patient for surgery. This treatment chart is custom made according to your symptoms and does follow the guidelines to treat both allergies with sinusitis.

The following things can be considered.

1. Wear an n95 mask at all times, do not allow any dust or irritative substance from entering into your nose. This is the most important thing you should be following failing which, no treatment will bring any relief.

2. Tablet Sinarest (or its equivalent) one tablet two times a day after food 12 hours apart for 15 days.

3. Tablet Allegra M (or its equivalent) one tablet two times a day after food 12 hours apart for 15 days.

4. Tablet Zerodol TH 4 mg (or its equivalent) one tablet two times a day after food for five days.

5. Tablet Clarithromycin 500 mg one tablet two times a day after food 12 hours apart for 15 days.

6. Duonase (Azelastine Hydrochloride and Fluticasone propionate) nasal spray (or its equivalent) two puffs two times a day in both nostrils for three months (do not inhale while you spray the drug).

7. Tablet Mucomix (Acetylcysteine) 600 mg (or its equivalent) one tablet two times a day 12 hours apart after food for one week.

8. Tablet Wysolone 10 mg one tablet after breakfast for one week.

9. Steam inhalations three to four times a day.

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

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

All precautionary measures have to be followed strictly for maximum relief, otherwise medications would not be useful on long term.

Surgery can be considered (if above medications and precautionary measures do not give any relief), but there is a catch to it. The symptoms might come back sometimes even on a higher scale after a brief relief following surgery if the precautionary measures post-surgery are not followed. Ideally speaking in a nutshell, I again emphasis on 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.

There is nothing that you need to worry about, once you follow the advice mentioned above, your symptoms should start coming down and I am sure you will recover with time. I hope this helps.

Thank you doctor,

From the last two months, mostly we tried all medicine but it did not help much. No, she gave up and want to do surgery. So can we opt for surgery without making it delay as her health is running by taking a load of medicines for the last two months and now her body is not supporting the pain?



Welcome back to icliniq.com.

As I said, surgery is not going to completely solve the problem in your case. The CT scan also does not look so abnormal that you require immediate surgery. I would still recommend finding out the root cause and treat it medically first rather than jumping into an unnecessary surgery which will not bring any long term relief.

Migraine can also be a related cause here which is causing an extreme amounts of pain and fainting attacks. In case of very severe intolerable headaches, you can also take Naxdom 500 mg and not otherwise. Make sure the triggering factors to the headaches are identified. With this half, the problems get solved and rest the medications should definitely bring relief.

I hope this helps.

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