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Have sinus. Took antibiotics. Having raw feeling and pressure in nose. What can be done?

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ENT Specialist
Practicing since : 1991
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I have had problems with my sinuses for the past three years. It all started three years ago when we moved into a 100+ yr old building. My desk was under a vent that blew on the left side of my head and face. Incidentally, my sister sat at my desk one day and rash developed on left side of face and neck.

A couple months after we moved into the old building, I was diagnosed with three sinus infections over the course of three months. I took antibiotics but my symptoms persisted. I then had a CT of the sinus which was clear.

An ENT suspected a mold allergy so we moved out of the building. I still have the following symptoms: The left side of my sinus feels raw and often cold when I breathe in. Both sides of my nose pop and lets out air bubbles. This will relieve the raw feeling and pressure in my nose when this happens. My nose tends to pop when I exercise, bend over, get nervous or anything that increases blood flow. I sneeze multiple times a day. My eyes burn and water. My ears randomly pop and crackle. When I use a neti pot water will randomly pour out of the left side of my nose hours afterward. I do NOT have congestion or a runny nose.

My questions are:
1. Could this be an undiagnosed hidden fungal infection?
2. What are the reasons for air bubbles in the sinus? Inflammation? Polyps?
Posted Sun, 18 Aug 2013 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 56 minutes later

Thank you for your query.

1. This seems to be an allergy to a fungus. AFRS (Allergic Fungal Rhino Sinusitis) has a vast spectrum varying from invasive fungal sinusitis to just the presence of the fungus in the sinuses (but technically outside the body).

2. MRI Scans may help detect fungi in the sinuses that are often missed on CT Scans.

3. The bubbling and popping may be due to the presence of thick muco-pus. Persistent inflammation may be blocking the sinuses.

4. Steroid sprays are toxic to the fungi but help reduce inflammation and allergy. Anti-fungal medication may not work if the fungus is present in the sinus cavities and not in the lining (mucosa) or the body. It must be kept in mind that certain or some of the changes may be irreversible.

5. If you can share your Sinus CT and MRI images, newer treatment options such as medications and Balloon Sinuplasty may be discussed.

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

Above answer was peer-reviewed by
Follow-up: Have sinus. Took antibiotics. Having raw feeling and pressure in nose. What can be done? 1 hour later
Thank you for your reply.

1. Since I have these symptoms daily would this mean I could have fungus latched onto the lining of my sinus? Rather than an allergy to fungus in the air?

2. Do ENTs typically do MRI scans of the sinus? They've only suggested CT. Do I need an ENT for this or can my general physician order an MRI of the sinus?

3. Muco-pus: Is this so thick that it does not drain from the nose? I never have any discharge or anything from my nose. Would it also make sense that I don't have any congestion in the nose?

4. I will ask my doctor for a steroid nasal spray. Could this be all I need to rid myself of the fungal infection? What do you mean by some changes may be irreversible?

5. My sinus CT is almost three years old - it was done around the time all of this started.
Answered by Dr. Sumit Bhatti 8 hours later

Thank you for writing back.

1. It is possible that the fungus is still there as you have now moved away from the old building.

2. ENT Specialists ask for CT Scans because bone is invisible on MRI Scans. However in such situations MRI scans may also be done as they are superior in soft tissue imaging. I have also seen MRI Scans pick up fungal infections that CT Scans have missed. At the same time, CT Scans are important if an operative procedure is planned. Both are important imaging systems. The information of both together is superior to each alone.

3. You may have para nasal sinus blockage without any nasal discharge or congestion in the nose itself. Mucopus may be so thick that it will not drain easily.

4. Steroid nasal sprays will be one of the treatments. The spray may not enter the blocked sinuses. You may require a procedure to improve the ventilation of the sinuses. Repeated inflammation may be accompanied by scarring during healing. Scar tissue cannot be treated. You may require ant-histamines and anti-leukotrienes and saline nasal irrigation in addition. 'Biofilm' formation in the sinuses is a new concept.

5. You will require the latest CT and MRI Scans. You may use the older CT Scan for comparison.

6. The problem will be if both your Scans come normal. Extremely minute details, functioning of the sinuses and many other details cannot be seen on scans. Your nasal endoscopy is also important.

7. A lot about fungi is unknown. They are a distinct species, different from plants, animals and bacteria. If you can imagine the entire history of life on Earth (4.8 billion years) as a 12 hour clock, and if the present is 12 o'clock midnight, then fungi appeared on Earth at 8 o'clock (2 billion years ago). Humans on the other hand appeared at 11:56 or 4 minutes to midnight. So we are probably the irritants to the fungi. It is also estimated that there are several tons of fungus in comparison to each individual present on Earth. The fungi are everywhere, though we may respond differently to them. People who are allergic to or are immunosuppressed suffer the most.

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

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