How to manage sinus issues after the surgery?

Question

Hello doctor,

I have been suffering from sinus issues for a while. I had surgery to open the blocked airways. But my nose is still swollen, my ears are ringing, and I could feel some discomfort in my nose. I do not get much discharge, and my nose does not produce any snot. These symptoms will subside for a while and reappear in a week or two. My nose swells up and remains infected for three to four days.

Once I recover, it stays fine for another week or two, and it recurs. I have tried eliminating all possible airborne allergies. I sleep beside high-efficiency particle-arresting (HEPA) filters. My house is spotless. And also, I modified my diet by eliminating dairy, gluten, and sugar. But I still have these issues. I randomly noticed my food chunks go into my sinuses. I am wondering could the food particles go inside and get trapped in my sinus cavity. My body then reacts and blows up to rid of the foreign object. Is this the reason for the ongoing cycle?

I used Claritin, Dymista, antihistamines, and steroid sprays, but nothing helped. I always wake up with a puffy nose and eyes. That has been an issue in the past year.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Kindly let me know a few more details. These include:

1) What surgery was done? Kindly attach a complete discharge summary.

2) Kindly attach the report of the allergy prick test. Also, let me know the allergens, including food allergens and aeroallergens like dust mites, various other dust, pollens, fungi, animal dander, etc. If you have not yet tested, then kindly do the test and attach the reports.

3) Please let me know the blood levels of vitamin D3, vitamin B12, thyroid function test, and blood sugar levels.

4) Do you have any additional medical conditions like diabetes, high blood pressure, or any form of immunosuppression?

5) The theory of food particles going up into the nose and the sinuses is a little far-fetched. But acid reflux can produce symptoms similar to that. In rare cases, acid reflux is known to cause such issues. Do you have any other reflux-related symptoms?

6) Do you smoke, use vape, or any inhalant drugs?

7) Have you done any CT (computed tomography) scan or nasal endoscopy after the surgery?

Kindly answer my questions and if possible kindly attach a picture of the lesion so that I can see the lesions and help you to my best.

I hope this helps.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

1) The septal correction surgery improves the airway but does not do anything much to the sinuses. Hence we need to do an endoscopic sinus surgery.

2) Regarding the allergy prick test you have done already, why did they not suggest immunotherapy? Here, if you have tested positive for an allergy test and if it correlates with the symptoms and clinical findings, it is advisable to start on allergy vaccines. They are otherwise known as allergen immunotherapy.

3) Need not repeat the skin allergy test if the initial one was done at a good laboratory. However, if the initial one failed to show any positive allergens, I suggest you do a blood immuno-CAP test (specific immunoglobulin E). Usually, the skin prick test is better and more efficient than the blood allergy test.

4) A nasal endoscopy will rule out any polyp or mass inside the nasal cavity. If the endoscopy is not satisfactory, kindly do a CT (computed tomography) scan of the nose and sinuses.

5) In addition to the blood tests for allergies which would include the immuno-CAP test, it is advisable to do serum immunoglobulins test, total white blood cell count, differential white blood cell count, thyroid function test, vitamin D3, vitamin B12, fasting and postprandial blood sugars, and HbA1C (glycated hemoglobin).

6) The flaring of symptoms at night need not necessarily be due to reflux alone. It could be due to indoor allergens like dust mites or molds. You can try taking an antacid for a week and see if this particular symptom improves.

However, if you can provide the computed tomography (CT) scan films and blood reports, I would suggest more measures that can help relieve your symptoms. There is a new drug called Dupixent (Dupilumab) (monoclonal antibodies). It is usually given to patients with nasal polyps. Although the use of Dupixent is not yet approved officially against nasal allergies, we have given it to a few patients, and they have received excellent relief. But that can be done only after a nasal endoscopy, or CT scan, and if the immunotherapy fails.

I hope this helps.

Thank you and take care.

Regards.