Hi,

Thank you for your query.

1. The cause of your problems is Biofilm formation in your sinuses. There may be associated allergic, fungal and mucus related conditions. The simplest example of Biofilm is the sludge or slime seen in drainage pipes or the moss seen along water channels. The Biofilm represents colonies of different types of bacteria living together like a 'city' with different micro organisms taking up different tasks or 'profession's like we do in our communities. Some of them secrete a matrix that protects them all. Due to close proximity, these bacteria share genetic material and may be genetically distinct from those that are grown in lab cultures. Hence they do not respond to the same antibiotics that they show sensitivity to in lab studies.

2. Bacteria like E coli are notorious for antibiotic resistance and can cause other species like staph to become more resistant by exchange of genes and chemicals.

3. I would like to see any CT Scans that may have been done in the past. You may share them on free file sharing sites such as  WWW.WWWW.WW  The reason is to see if the previous treatments were appropriate and aequate. This is because poor ventilation and drainage of your sinuses is the most important cause of Biofilm formation.

4. You should wash your sinuses with a solution of normal saline with a pinch of salt and baking soda added to it. This alkaline nasal douche will help break up the Biofilm and allow penetration by other antibiotics. You may add an antibiotic like tetracycline or chloramphenicol. However this should be done under medical supervision.You may try higher generation antibiotics such as cefprozil or ceftriaxone, again to be administered only by your local doctors. You should draw their attention to Biofilm formation, which is a relatively new concept.Supportive treatment such as mucolytics, anti allergics, anti fungals, steam inhalation and dental hygiene should be taken. Surgical debridement, removal and disruption of the Biofulm requires repeat or revision surgery.I hope that you do not have any other immune suppressive disorder such as diabetes. In such cases oral steroids are contra-indicated.

I hope that I have answered your query. If you have any further questions I will be available to answer them.

Regards.

---

Hi

Thanks for the query

It is very unusual for the Escherichia Coli (E coli) to be seen in the nasal cavity and treating the same is a much more difficult task. Very few medicines act effectively against Ecoli.

Taking mere antibiotics will not help in resolving sinusitis, you need to follow the preventive measures such as drinking plenty of warm water, doing steam inhalation, using saline nasal spray and taking mucolytics (such as bromhexine or ambroxol). Also, you will require a potent steroid nasal spray (such as fluticasone or momentasone) to reduce the nasal congestion. Avoid scuba diving when you are having sinus infection.

The ear blockage is due to closure of the Eustachian tube (the tube connecting nose and the ear) following nasal congestion and sinusitis. The above measures will help in relieving the block.

Finally, intratympanic injection of steroids is not going to help you in relieving the sinusitis.

Hope I have answered your query: I will be available for the follow-up query.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

---