Dr. Shyam Kalyan. N
Otolaryngology (E.N.T)
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Patient's Query
Hello doctor,
I had a tooth extracted, and it resulted in the perforated sinus. I was on antibiotics Amoxicillin for seven days before and three days after the extraction. I took all the medicines on the sixth day I got a bad sinus infection. I went to my primary care doctor she put me on Amoxicillin once again. She told me to go back to the dentist if there is no improvement. I went back to the dentist, and she prescribed Augmentin and advised to go to an oral surgeon, and he confirmed the sinus perforation. He told me it was healing and told me to stay on antibiotics come back in two weeks for follow-up. After six days on Augmentin, I am still having bad headaches in the front by my eye and a lot of sinus pressure. I am taking the Augmentin, Sudafed, Off Brand Flonase, Tylenol, Ibuprofen 800, and Asprin alternating. Should I be taking another type of antibiotics, or do you feel the Augmentin is working?
Hello,
Welcome to icliniq.com.
Did you get a CT scan done to see the size of the fistula? It's called an oro-antral fistula. If it is big then it may have to be corrected surgically. Additionally if the infection is not healing one can give a thorough antral wash and wash out the contents of the sinus in an operation theatre under anesthesia which will help in bringing down the load of infection and help the antibiotics act. Since you have taken amoxicillin/augmentin for quite some time, I also feel the antibiotic can be changed into a stronger one with a broader action, say like Levofloxacin and Metronidazole.
Patient's Query
Thank you doctor,
No cat scan as of yet the oral surgeon thought it was healing just slowly. I will contact and ask to be put on a stronger antibiotic. Is either of those antibiotics you recommended sulfur-based as I am allergic to sulfur drugs makes my mouth tingle? If he suggests repairing it in another week should I see an ENT first as they could probably improve and flush the sinus cavity at the same time correct? Last question we have a vacation planned for in two weeks we will be flying there any suggestions for the flight? I am afraid this will get worse.
Hello,
Welcome back to icliniq.com.
None of those a robotics is sulfur based. Metronidazole gives a metallic taste to mouth though. The ideal way would take a sterile swab of the secretions from the fistula or nose and send for culture sensitivity to see the most appropriate antibiotic. The sinus washes out can be done by an ENT surgeon only. Oral surgeons may be able to correct the oral part of the leak or connection using a flap. But before such surgery, the infection should resolve completely. Also, sinus washes out, and an endoscopic sinus surgery will help remove sinus secretions and inflammation. The repair would be needed only if conservative management fails. I suggest you do not take your holiday now till you get the issue completely corrected. If it gets flared up during your holidays, it may become a more significant issue. Regarding the flight, there are no restrictions. But when you have an ongoing issue, it is better to get it resolved before undertaking a vacation.
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Otolaryngology (E.N.T)
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