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Suffering from sinus and allergy. Prescribed forenza 325mg and emlukast LC Tab. Any advice?

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Hi my wife is having sinus from past 10 years.When she gets some allergy she gets this problem causing severe nose pain and headache. Doctor has advised for CT-PNS. He also prescribed forenza 325mg, emlukast LC Tab, Olace Tab, Lazacort 6 for relief. Kindly advice...
Posted Tue, 2 Oct 2012 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Sumit Bhatti 1 hour later
Hi,

Thank you for your query.

1. A plain CT PNS (Para Nasal Sinuses) will once and for all settle the issue whether she has sinusitis or not. Chronic sinusitis should receive a trial of medication initially. The scan should be on a new generation multi-slice scanner with 1 mm coronal, axial and sagittal cuts.

2. Blocked sinuses are poorly ventilated and along with stasis of secretions, continuing infection and inflammation is common. Pain and pressure in the face, forehead and around the eye is common in sinusitis. Inflammation and pus makes it difficult for antibiotics to act. Sometimes, the infection is fungal and hence medication does not help. Hence supportive treatment is required. Local decongestant drops may be used to reduce the pressure. Sometimes, nasal pain is due to mucosal contact (inner linings or structures in the nose touching each other).

3. You need to get an ENT Specialist to examine her nose, sinuses and ears again. A nasal swab or any discharge may be sampled for culture and antibiotic sensitivity. Sometimes there is a 'biofilm' formation which causes chronic sinusitis. A plain CT PNS (Para Nasal Sinuses) will definitely help understand your problem.

4. She may require a further course of antibiotics, pain killers, anti-allergics, decongestants, mucolytics and steam inhalation. This should be done under medical supervision. I would recommend a steroid nasal spray and an anti-histaminic (a first line anti-allergic, though emlukast is good it is another type of supplementary anti-allergic). If the Tab. Olace is olanzapine (an antipsychotic) then it may be causing nasal side effects. There is also no painkiller (anti-inflammatory) in her prescription.

5. You may share her CT Scan and investigation reports here for more specific treatment options. For example, if her Sinus CT is normal, a Neurologists opinion on neuralgias and migraine will be required. Balloon Sinuplasty may be an option if the sinus pressure persists. Radio-frequency and Co-ablation assisted surgery are also newer options as compared to FESS (Functional Endoscopic Sinus Surgery).

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

Regards.
Above answer was peer-reviewed by
 
Follow-up: Suffering from sinus and allergy. Prescribed forenza 325mg and emlukast LC Tab. Any advice? 36 hours later
Hi doctor
Thanks for your reply. Iam attaching the Scan Report of my wife. The doctor here says she needs a FESS. Please give your thoughts on this so that i can plan for next course of actions.
 
 
Answered by Dr. Sumit Bhatti 11 hours later
Hi,

Thank you for writing back.

1. If you can share the CT Scan images, I will be able to give you an accurate assessment.

2. As per the CT Scan report, a Mini-FESS or Balloon Sinuplasty on both sides to open the blocked maxillary and ethmoid sinuses will suffice.

3. A Septoplasty may be required for correcting the DNS to Right, if it is severe or has a prominent spur. Alternatively, if the DNS is mild, radio-frequency ablation of the inferior nasal tubinates on both sides will suffice in opening the airway and ease the headache and nasal pains. There is always caution advised in expecting total relief if the cause of the headache pain is not established, for example in migraine, cluster headaches and so on.

4. Once ventilation improves, the nasal lining (mucosa) will gradually start healing over many months. Allergy will not be cured by surgery, Long term medication will be required to control her allergy.

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

Regards.
Above answer was peer-reviewed by
 
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