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Green mucus discharge through nose and throat, coughing, acidic secretion. Whom to consult?

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Internal Medicine Specialist
Practicing since : 1996
Answered : 961 Questions
I experienced white nasal discharge and frequent cough with fever from Dec 2010. I had been diagonised for deviated nasal septum with sinusitis and I had undergone functional endoscopic sinus surgery during Sep 2011 for the same. Even after the surgery I experience the same. Now the mucus, which is greenish, is discharged through nose and throat (when I cough ). Cough is also persistent through out the day. I also experience secretion of some acid type fluid after 6 P M at work which adds to the problem. It is true that my environment is pollutive. I couldnot control my cough throughout the day. Homeopathic consultant says that it is because of allergic bronchitis. Kindly suggest me the exact consultant/specialist with whom I can consult to get rid of the same.
Posted Fri, 21 Sep 2012 in Ear, Nose and Throat Problems
Answered by Dr. Prasad Akole 2 hours later
I see that you have symptoms of chronic sinusitis even after sinoscopy surgery, which is the procedure of choice if there is any obstruction or polyps etc.
Persistence could be due to recurrence of obstruction, polyps, or chronic infection. Allergic rhino- sinusitis is also common.
I would like to know the results of any tests done and the antibiotics / other medicines that you take. (Please use the up loader available to the right of your text box on this site) The cough, discharge etc, are due to post-nasal discharge trickling on the back of your throat and nose.
You need a complete haemogram, ESR. AEC (absolute eosinophil count), X-ray chest, if not done in the recent past. A culture of the sinus/ nasal discharge may give a clue. if it is really distinguished from saliva.
Allergic component may be treated with an anti-allergic tablet daily, a long term suppression of allergy with mast-cell stabilisers (to stop release of allergy producing chemicals). Antibiotics appropriately to treat infections. There are sprays available convenient for use.
Avoid obvious precipitants of cough, watering eyes, nasal discharge, sneezing ( all indicating allergy).
Please post these details to help me guide you better. Take care and please keep me informed of your progress.
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Follow-up: Green mucus discharge through nose and throat, coughing, acidic secretion. Whom to consult? 17 hours later
Thank you Doctor for the reply. Following are the medications I had during XXXXXXX 2012 after surgery in Sep 2011.
1) T. Clavam 625 mg 1-0-1
2) T. Hifenac P 1-0-1
3) T. Nukast 10 mg 0-0-1
4) T. Ato Z 1-0-0
5) Syp Ambrolite
6) Flomist Nasal Spray
Subsequently I turned to Homeopathy from which also I face no remedy. Eosinophil count during 11.06.11 was 5%(during surgery) and 1% on 20.04.12( during malaria). Now tell me the treatment I should follow. Also tell me whether my problem is related to gastro enterology?
Answered by Dr. Prasad Akole 4 hours later
Dear friend,

Thanks for reverting with information.

Good that 2 occasions show normal eosinophil counts, mostly ruling out allergy as antiallergics, topical steroids and mast cell stabilisers that you were given failed.

I now feel that it is chronic sinusitis either due to resistant bugs or unrelieved/ recurrent obstruction.

Sometimes GI (GastroIntestinal) pathology like acid reflux disease etc. is thought to be implicated in such cases.

I would advise a different antibiotic class (clindamycin and levofloxacin) by mouth (if no allergies to them) under supervision of an ENT doctor, nasal saline drops/ spray and nasal xylometazoline spray, omeprazole 20 mg daily once for 2-3 weeks.
You may stop the steroid spray.

A non sedative anti allergic like fexofenadine, steam inhalation 3-4 times in a day might help you too.

If this does not help (a small % are non-responders for any disease), I would advise a visit to a gastro-enterologist to work up for dyspepsia and an ENT opinion (may be 2nd opinion at a reputed institute) on surgical options and sinus culture sensitivity to guide antibiotics.

Rule out immuno suppression, fungal sinusitis, diabetes etc.
If you could upload older reports, scans etc, it could be of great help. (There is an uploader on this site on your right near the text box). You may use it to discuss further.

Take care and please keep me informed of your progress.
Good Luck !

I hope to have answered your query satisfactorily.
May I request for your rating and review of this answer before you accept the answer (press the XXXXXXX Accept "button) and close the query (if there are no more follow up questions)?

Thank you !
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