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Have moderate sinusitis, rhinitis and enlarged turbinates. Getting headaches in the forehead. Good to use saline?

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ENT Specialist
Practicing since : 1984
Answered : 1971 Questions
I have moderate sinusitis, rhinitis and moderately enlarged turbinates. These likely cause headaches in the forehead area, although they also appear on the sides of the head. My eyeballs in particular also feel the dull pain.
What do you recommend as immediate treatment. Would a saline spray be a good idea? I did not have a saline spray but tried steam inhalation once and it seemed to take away the eyeball pain completely. Would regular steam inhalation also be helpful?
I have also been prescribed antihistamines in the past. What is the best way to prevent the issue from becoming chronic, as I have seen how serious the condition becomes when the turbinates become permanently enlarged.
Posted Sun, 31 Mar 2013 in Headache and Migraines
Answered by Dr. A.K. Srivastava 1 hour later
Thanks for writing to H.C.M. for query
I have gone through your query regarding Frontal headache nd pain over eyeballs. As you said that you are having moderate sinusitis, Rhinitis and turbinate hypertrophy. These three things in nasal cavity and sinuses are inter related.For proper management for these you have to do these basic investigations-
(1) C.T.scan of paranasal sinuses.
(2) Culture and sensitivity of nasal swab.
(3) Blood- CBC, ESR, blood sugar- F. & P.P.
(4) Urine- Routine and Microscopic.
After this much work a tharough examination of nose and throat along with clinical co-relation with inferences of investigations one can reach to final diagnosis than after treatment may be plan accordingly.
Depending on involvement of different sinuses and turbinates and there etilogy (basic pathology may be allergic or infective) treatment is planed.
If etiology is supposed to be allergic than surgery will not give good result and in such cases conservative treatment is always helpful. Coservative treatment is given in the form of antibiotics, antiallergic, Decongestant and steam inhalation. In such cases steroidal nasal spray are to be use for long time.
On the other hand if pathology is infective and osteomeatal complex is found blocked than surgery is the treatment of choice.

I hope your query is explained but if still any doubt you can clear it.

With Regards.
Above answer was peer-reviewed by
Follow-up: Have moderate sinusitis, rhinitis and enlarged turbinates. Getting headaches in the forehead. Good to use saline? 21 hours later

Thanks for the suggested course of action. I am wondering what would be the main purpose of the blood and urine tests. Would they test how likely inflammation would be in the sinuses? I do have the culture of staph infection from a swab taken at the back of the nasal cavity.

Do the conservative treatments you have suggested prevent any inflammation from becoming chronic so that the use of nasal steroid sprays might prevent the turbinates from becoming permanently enlarged? What are the suggestions for some anti-allergenics or decongestants or are these to be decided based on investigations?

What is your opinion on saline spray solutions for management of the condition?

Answered by Dr. A.K. Srivastava 5 hours later

Thanks for writing back to us about your doubts.

Here first of all I would like to tell you importance of each investigations which are being advice to you.

C.T.scan of paranasal sinuses- The sinuses in our head are divided in two groups-
(1) Anterior group- This include one frontal sinus , one maxillary sinus, anterior and middle ethmoidal air cells.
(2) Posterior group- This includes posterir air cells and sphenoid sinus.
Both these groups are present on either side of nose in different facial bones.
In sinusitis any one or more than or some times all the sinuses are involved. So before treatment one should know the real extent of disease. This can be find out by only C.T.scan.

Culture and sensitivity of nasal swab- this is for identification of causative organism and which antibiotic will be most effective in your infection.

BLOOD TEST- I n blood I have advice CBC- This is a basic test here if LYMPHOCYTE count is raised that indicate chronic infection, If POLYMORPH count is raised that indicated about acute infection. Increase count of ESINOPHILL indicates about ALLERGIC disorder, I have advice for BLOOD SUGAR to rule out diabetes because in diabetic patients till blood sugar is not maintaine nobody can control infection and allergy.

URINE TEST- IN urine I have advice only routine and microscopic examination, This is also a basic test to know your renal status because any medicine whatsoever you are to be advice will be excreated out of your body by your kidney, if kidney functions are compromised than one will give medicine with extra care to save you from unwanted side effects.

I have already told you that rhinitis, sinusitis and turbinate hypertrophy are inter related.The pathological process is as- Rhinitis give rise to sinusitis and turbinate hypertrophy . On the other hand sinusitis also induces turbinate hypertrophy. In this way for proper treatment one should manage tis triad treatment for one will always fail.

You have asked about saline nasal wash- this will help for your problem for some time only because by this method we can thin out collected discharge and also to clean it but neither it will cure sinusitis nor turbinate hypertrophy.

I hope your queries are replied with explanation but we welcome for remaining doubts as well.

With Regards.

Above answer was peer-reviewed by
Follow-up: Have moderate sinusitis, rhinitis and enlarged turbinates. Getting headaches in the forehead. Good to use saline? 28 hours later

Thanks for the detailed information. As inflammation definitely was detected in my sinuses, I have used a nasal steroid previously (Avamys), which itself may have caused an allergic reaction as I noticed a runny nose on the side which received the spray. It lasted about one week. Is this a normal reaction perhaps to steroids or more likely the unique formulation in Avamys? Could it be worth trying a different nasal spray?
Answered by Dr. A.K. Srivastava 3 hours later

Thanks for rewriting to us about your query.

As you noticed that Avamys seems to have some alleric to you, it will be better to change the spray.Secondarily if you are a pure allergic case than you may go -

(1) Skin test- This test is being done by chest specialist, by this test one can know about particular allergen which is giving you problem.Once the allergen is identified than your body may be desenstized by suitable vaccines, in this way you will get prolong effect.

(2) With the concent of your doctor you may take injection histaglobulin sub cutaneously at weekly interval for three times to get prolong effect.

(3) With the concent of your ENT doctor you may take injection of depomedrol sub mucus over inferior turbinate to get prolong anti allergic responce.

(4) Lastly if your nasal cavity is fit than you may go for turbinate reduction by laser or coblation these are very short proceedure and no hospitalization is requared. If it becomes succesful than you may be free from nasal obstruction.

With Regards.
Above answer was peer-reviewed by
Follow-up: Have moderate sinusitis, rhinitis and enlarged turbinates. Getting headaches in the forehead. Good to use saline? 10 hours later

Thanks for the additional information and it certainly will give me some directions as to how to approach the problem.

Best regards.
Answered by Dr. A.K. Srivastava 4 hours later

Dear XXXXXXX I am very happy on your satisfaction, I will pray for your speedy recovery.

With Regards.
Above answer was peer-reviewed by
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