What could cause debilitating sinus pressure?

Question

Hi doctor,

I have had significant, debilitating sinus pressure for the past month, which has gradually worsened. I initially thought that this was due to allergies since I recently moved to my hometown, which is very lush. I now do not believe that the pressure is caused by allergies. I just went back home, and the symptoms persisted; the pain or pressure is only in the right side of my forehead, nose, or eye area. I am not getting my normal allergy symptoms (itchy eyes, sneezing). I am not responding to allergy medication (Nasonex, or Pataday). I have been on antibiotics (Augmentin) for 24 hours and do not feel any better, though. I appreciate that it might take some time to properly work. I have no fever. I have very little mucus. So I think that my sinus may be blocked. The only medications that help are Sudafed and Advil, which only attack the symptoms, not the root cause. My questions are:

1. Are antibiotics the right course of treatment?

2. What is the next step if I do not improve with antibiotics?

3. What are possible explanations for my symptoms?

These sinus issues are significantly impacting my quality of life. I hope to figure out what is going on soon.

Answer 1

Hi,

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You seem to be suffering from acute rhinosinusitis. The sinonasal mucosa has got inflamed due to some reason, causing blockage of the sinus. Ostia causes stasis in secretions and added infection, causing pain. The stasis of secretions causes the growth of bacteria which produces symptoms of infection, pain, fever, headache, and thick nasal discharge. Allergy can be a local trigger for the inflammation leading to further colonization by pathogens like bacteria. Allergy cannot be ruled out though you are not finding relief with Patanase and Nasonex because it would have been only a triggering event.

I would advise you to continue antibiotics for the full course along with Sudafed (Pseudoephedrine). Advil (acetylated monoglycerides) may be taken on an emergency basis as it is only a painkiller. Antibiotics are the right course of treatment for now. You may use Otrivin (Xylometazoline or Oxymetazoline) nasal drops on each nostril to relieve the block. If you are not improving with antibiotics for more than four days. I would advise you to go to the doctor. We would want to do a nasal endoscopy and see inside the nose and also take a pus swab for a culture sensitivity test. If necessary, we may ask you to do a non-contrast computed tomography scan of PNS (para nasal air sinuses). These tests, coupled with routine blood investigations, will give us good details on what is happening inside and help suggest any change in treatment necessary. If symptoms recede temporarily and relapse after some days or weeks, we may also want to evaluate you for allergy. Allergy tests can be skin prick or blood tests.

Thank you.

Wishing you healthy and happy times ahead. Reach us as and when you need help.

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