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Dr. Andrew Rynne

Family Physician

Exp 18 years

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Have reoccurring sinus infections and bronchitis. On medication. Any effective medicine?

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ENT Specialist
Practicing since : 1991
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I have reoccurring sinus infections and bronchitis back-to-back now for months; getting worse and more frequent each year. I simply can't stop coughing, and am drowning in XXXXXXX mucus from my nose and in my lungs. I've just gotten off of the strong antibiotic, Augmentin, two weeks ago and am not wanting to take antibiotics again unless necessary. I have been sick with this 4 out of 5 of the past weeks, with only a 1-week break about a week and a half ago. I am going to have my doctor screen me for both nose polyps and lung cancer. In the meantime, I am drowning in mucus, cannot get a full breath, can't stop coughing, and my lower throat and the muscles and so forth just above my collarbone on both sides are extremely sore to the touch. Please help. My doctor's appointment isn't until tomorrow and I'm suffering a lot and am a single mom living alone with a baby and a kindergartner so if I don't feel well I still have no choice but to care for them or they'll be neglected. I'm so sick of going to the doctor every other month or more for sinusitis and bronchitis. There's got to be something else going on besides a cold or flu over and over and over and over again. I'm antibiotic resistant as a result and have, the last few times, taken Augmentin and I think I'm even becoming resistant to that because I just got off of it not even two weeks ago and now I'm sick again with the same thing! I can't take a full breath at all; coughing so that I cannot sleep all night even with NyQuil and cough drops; and feel like I'm drowning in this XXXXXXX mucus. ~Desperate
Tue, 18 Dec 2012 in Asthma and Allergy
Answered by Dr. Sumit Bhatti 2 hours later

Thank you for your query.

1. Sinusitis lasting for more than six weeks in spite of adequate medical treatment is termed as Chronic Sinusitis. Antibiotics will not work in fungal infections.

2. You should get the XXXXXXX nasal discharge collected in a sterile container and sent for bacterial culture and antibiotic sensitivity.

3. Blocked sinuses are poorly ventilated and along with stasis of secretions, continuing infection and inflammation is common. The mucus drains into the throat as a Post Nasal Drip (PND). 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 blockage. This PND worsens any pre-existing bronchitis. Do you have Eosinophilia or Acid reflux? Have you had a Chest X-ray?

4. I would like to introduce you to the concept of Biofilm formation in your sinuses. The simplest example of Biofilm is the sludge or slime seen in drainage pipes or the moss seen along water channels. The Biofilm represents colonies of different types of bacteria, fungi living together like a 'city' with different micro organisms taking up different tasks or "profession's" like we do in our communities. Some of them secrete a matrix that protects them all. Due to close proximity, these organisms share genetic material and may be genetically distinct from those that are grown in lab cultures. Hence they do not respond to the same anti-fungals and antibiotics that they show sensitivity to in lab studies. This would explain the developing antibiotic resistance.

5. You should wash your sinuses with a solution of normal saline with a pinch of salt and baking soda added to it. This alkaline nasal douche will help break up the Biofilm and allow penetration by other antibiotics. You may add an antibiotic like tetracycline or chloramphenicol. However this should be done under medical supervision.

6. If you are preparing the saline solution at home,
(i) I will recommend that you use Normal Saline 0.9% which is used for IV infusions.
(ii) Household salt may contain anti-caking agents and too strong or too weak a solution will damage your delicate nasal mucosa.
(iii) If you still want to prepare the solution at home prepare a mixture of Sodium bicarbonate (loosens crusts) 50 gm, Sodium biborate (antiseptic) 50 gm, Sodium Chloride (for isotonicity) 100 gm and then add 1 teaspoon to 300 ml XXXXXXX warm water.
(iv) Another option is to add a pinch of baking soda to a pinch of common salt, + XXXXXXX warm water,
(v) Attach a piece of rubber catheter to a 20 cc disposable syringe. Keep your head bent forwards and downwards, mouth kept open while performing this alkaline nasal douche.

7. An ideal treatment combination includes an anti-histamine like levocetrizine or rupatidine, an anti-leukotriene, a steroid nasal spray, saline nasal washes and steam inhalation. Supportive treatment such as decongestants, mucolytics dental hygiene should be taken.

8. You may share your CT PNS (Para Nasal Sinuses) Scan and investigation (blood) reports here for more specific treatment options. For example, if your Sinus CT is normal, only medication is required. Balloon Sinuplasty may be an option. Radio-frequency and Co-ablation assisted surgery are also newer options as compared to FESS (Functional Endoscopic Sinus Surgery) if you want to avoid major surgery since you are taking care of two young children alone.

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