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Being treated for sinus infection. Had severe vertigo, pressure behind eyes, tiny ear canals. Will I be okay in time?

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ENT Specialist
Practicing since : 1991
Answered : 2448 Questions

I am being treated for a sinus infection...I have been on my antibiotics for five and half days. It's a ten day course of treatment. I am still suffering from pressure behind the eyes, pressure around the airs and sometimes ear pain, and worst of all a persistent fairly severe woozy feeling. I have also had two severe vertigo attacks where I nearly fell down. I have extremely tiny ear canals and, probably eustacian tubes. I have to get my ears cleaned out by an ENT every six months. Anyway...if this dizziness and vertigo is being caused by a sinus infection, shouldn't i be feeling better by now? I'm really getting concerned.

ehem...that should be pressure around the 'ears' of course. Thank you.
Posted Wed, 4 Jul 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 36 minutes later

Thank you for your query.

1. There are many reasons for not feeling better. The organism may be resistant. The sinus infection may also have a viral or fungal infection which will not respond easily to antibiotics. Sometimes there is Biofilm formation. Do you have fever? Is the pressure feeling the same on both sides? Is this your first attack of sinusitis?

2. Blocked sinuses are poorly ventilated and along with stasis of secretions, continuing infection and inflammation is common. Inflammation and pus makes it difficult for antibiotics to act. Hence supportive treatment is required. Local decongestant drops may be used now.

3. You need to get an ENT Specialist to examine your nose, sinuses and ears again. A nasal swab or any discharge may be sampled for culture and antibiotic sensitivity. A plain CT PNS (Para Nasal Sinuses) will definitely help understand your problem.

4. You may require a further course of antibiotics, pain killers, anti-allergics, decongestants, mucolytics and steam inhalation. This should be done under medical supervision.

6. I would conduct a follow up examination to clear the following points:
a. Is the antibiotic ineffective? Usually, as you have correctly mentioned, you should be feeling better after 48 - 72 hours.
b. Is supportive treatment helping or are the sinuses still full of secretions? A Sinus X-ray may also be done at this stage if a scan is deferred. This would help assess the pressure behind the eyes and around the ears.
c. Are the eardrums bulging or congested? This would explain whether the vertigo is due to sinusitis or ear infection. A Tympanogram can detect fluid or pressure changes in the middle ear and evaluate eustachian tube function. A PTA (Pure Tone Audiogram) will help determine the hearing levels and provide additional evidence of ear blockage.
d. True rotational vertigo will occur with ear problems. Unsteadiness, dizziness and the woozy feeling may signify complications arising due to sinusitis.

7. You may share your CT Scan and investigation reports here for more specific treatment options.

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

Above answer was peer-reviewed by
Follow-up: Being treated for sinus infection. Had severe vertigo, pressure behind eyes, tiny ear canals. Will I be okay in time? 9 minutes later
Thank you for your very thorough answer. I have had sinus congestion before but never this severe...that is never so long-lasting and with dizziness. I have small everything--a small face and I would imagine, small nasal cavities to go with...

I suppose, then, I should call my ENT tomorrow and indicate I'm still quite sick after six days of the medication.

I am also using a netipot twice a day; I have no idea if this is helping. And he prescribed Avamys as well, which I just started six days ago.

What do you mean by decongestant drops? Would an over the counter decongestant table also be helpful?

If it's a viral or fungal infection is there anything that can be done?

What do you mean by true rotational vertigo? Are you saying that this is NOT likely what I have?

Many thanks. :)

Answered by Dr. Sumit Bhatti 37 minutes later

Thank you for writing back.

1. You should call your ENT Specialist tomorrow.

2. Do not use the Neti Pot during active infection.

3. Avamys (Fluticasone) is a nasal steroid spray. It may be taken under antibiotic cover. However steroids sprays may suppress the local immune response of the body and hence may flare up an infection. If you still have fever, discontinue the Avamys for some time.

4. OTC decongestant drops such as xylometazoline (Otrivin) and steam inhalation may help get immediate relief. Do not use OTC decongestant drops for more than two weeks as they cause rebound congestion.

5. Use of nasal and steroid sprays during viral infections may flare the infection up and will usually not prevent the ear symptoms that you are experiencing. Fungal infections are usually picked up on scans.

6. True Vertigo is a spinning sensation. Many patients have dizziness/ unsteadiness/ feel woozy/ light-headed/ feeling faint and mix up the terms with vertigo. Your ENT Specialist should look for nystagmus (abnormal eye movements seen during an episode of vertigo) and assess your hearing and ears.

Please follow the above guidelines and kindly let me know the results.

Wishing you good health.

Above answer was peer-reviewed by
Follow-up: Being treated for sinus infection. Had severe vertigo, pressure behind eyes, tiny ear canals. Will I be okay in time? 45 minutes later
Hello Dr. Bhatti,

Thank you. I will call him tomorrow. And I will get some Otrivin tonight. I am familiar with it. May I ask why I shouldn't use the Netipot? And he prescribed the Avamys so why would he do that if it could inhibit my immune system? I'm a bit confused. I do not have a fever, by the way. Just a moving headache, ear and eye pressure and pain. A very slight degree of nausea. For steam inhalation, can I just put boiling water in a bowl and place a cloth over my head? Old school...I know!

Sorry for all the questions, but I do appreciate your answers. The dizziness is scary.
Answered by Dr. Sumit Bhatti 10 hours later

Thank you for writing back.

1. You should not use the Neti Pot during active infection as it may spread the infection. You may use it later after the initial symptoms subside.

3. Avamys also helps reduce inflammation. That is why it may have been prescribed. I would recommend that you discontinue it during the acute phase of your symptoms. Anti-inflammatory medication, steam inhalation and Otrivin will suffice instead.

4. You can take steam inhalation with a bowl of boiling water. Try to take this for 10-15 minutes at a stretch.

5. Dizziness is scary and loss of confidence is common. Anti-vertigo medication may be prescribed by your doctor to relieve the dizziness.

Kindly let me know the results.

Wishing you a speedy recovery.

Above answer was peer-reviewed by
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