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Suggest Treatment For Sinus Infection And Chest Congestion

Posted on Thu, 5 Feb 2015

Question: Hi. I checked in with you before about sinus issues. What started as what appeared to be a bad sinus infection, possibly triggered by moldy furnace filters, and concentrated mainly on the left side (typical spot of sinus issues for over 20 months) was treated with antibiotics - 2 rounds the last was a cipro variant - and the fever and chills stopped. After a visit to my ent dec 3 he examined me and put me on entex la twice a day which I found too harsh and he cut dose in half. He Doubled my beclo/xylo spray dose to twice daily. After 4 weeks of this things started improving. Now after 6.5 weeks almost all symptoms have abated. Also two weeks ago started saline neti flushing. Up to 3-4 times a day focused on the left side. Feeling and looking much better. But still getting persistent though much much milder congestion and on left side, post nasal drip and the nasal passage feels quite irritated and sore halfway up nose and up to the bridge. Some pain behind one eye. Also getting evidence of blood when I flush and blow nose. Which is worrying. Though it seems just like its in the one nostril. Wondering if I'm neti potting too much. Can this cause problems? Also. The beclo xylo mix had caused me a couple alarming anterior nosebleeds on the other side when I started using it 10 months ago. The mixture is .036 %beclomathsene and .14% xylometazoline in solution. But it seems to work on congestion.

Answered by Dr. Naveen Kumar Nanjasetty (2 hours later)

Brief Answer:
Avoid the combination nasal spray and restrict neti-kriya for once a day...

Detailed Answer:
Hi

Thanks for writing back

1. The dryness of the nose is secondary to usage of steroid + decongestant nasal spray. Try to use plain steroid spray rather than the combination. Also, use the steroid nasal spray once in a day. Xylometazoline if over-used, can cause rebound nasal congestion and makes you feel as if you are having nasal congestion and once you reuse, the congestion reduces. Rebound nasal congestion is a major side effect of xylometazoline nasal spray.

2. Use saline nasal spray as frequently as possible. Saline keeps the nasal mucosa moist and re-hydrates the tissues and prevents bleeding and the nasal pain.

3. Neti-kriya should be done once in a day. Do not over do it. The hypertonic solution drains out the water from nasal mucosa making it dry and irritable.

4. Do not worry! With simple modifications you will definitely feel better. Normal saline (not hypertonic saline) can give you excellent relief. Please use it as frequently as possible. Do steam inhalation, steam is an excellent nasal decongestant.

Hope this clarifies your doubts. Revert back to me if you any further queries.

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

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Naveen Kumar Nanjasetty (2 hours later)

Hi thanks
Ok I did get the xylo concentration wrong. It's .014% not .14. At this concentration is it still likely to be a problem I will tray using it sparingly as the sensation is quite swollen and achey. Beat up. Also some tearing in one eye. Though it sometimes drifts to the other side. If this is the source of problems then need to g this changed. This is the ents special formula.
To clarify. What is hypertonic solution vs normal. ?

Answered by Dr. Naveen Kumar Nanjasetty (17 minutes later)

Brief Answer:
Dryness, pain and nasal irritation can cause tears

Detailed Answer:
Hi

Welcome back

1. In what ever concentration it is, xylometazoline should not be used continuously for more than 7 days. If used for more than the above mentioned days, the rebound congestion takes place which is known as 'rhinitis medicamentosa'.

2. Normal saline is 0.9% sodium chloride solution, which happens to be the normal constituent of the body fluids. Hence, usage of normal saline replenish the cells in the body and maintains the homeostasis.

Hypertonic solution is a mixture, wherein the concentration of sodium chloride is more than 0.9%. When the salt content is more in the extra cellular compartment, it draws the water from inside the cell, thus deranging the homeostasis in the tissues. This leads to shrinkage of the cell size and dryness of the mucosa.

3. Nasal irritation and pain can cause tearing in the eyes.

Hope this clarifies your doubts. I wish you good health.

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

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Raju A.T