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Dr. Andrew Rynne

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Have sore throat, headache and pressure around face. Using nasonex nasal spray. What to do?

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Dr. Sumit Bhatti

ENT Specialist

Practicing since :1991

Answered : 2561 Questions

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Posted on Tue, 18 Dec 2012 in Headache and Migraines
Question: Hello,I am returning from a week long vacation in Florida and I am currently in transit driving home to Chicago with my family. I have been very sick this entire week with a horrible virus. My sinuses have been terribly congested, my throat has been terribly sore at night, and I've had a persistent headache and pressure in and around my face (I have had coughing, sneezing, and a fever as well). I am very familiar with sinus infections, and actually had sinus surgery in 2004 to cure me of one that wouldn't respond to oral antibiotics. Anyway, I went to urgent care 4 days earlier and received a Z pak for my symptoms. My question is that ever since then I have been having this clear but Bright yellow fluid that literally pours out from my left nostril when I tip my head forward (and during the night while I am sleeping), and am curious if this indicates that I am having a bacterial sinus infection. I am also curious whether the z pak will be sufficient enough to cure it, or if I should see an ENT when I return for a better examination. I'm still having significant sinus pressure and congestion which I've been using a nasal decongestion spray at night so that I could sleep. For the last two weeks I was using Nasonex, but ran out of it while in Florida, so I stopped it earlier in the week. Is there anything else I can do to help rid myself of this in the mean time?
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Answered by Dr. Sumit Bhatti 1 hour later
Hi,

Thank you for your query.

1. You should discontinue the Nasonex (Mometasone) nasal spray for a few days as steroids tend to flare up an infection. You may have a secondary bacterial infection following the initial virus infection.

2. You should get the nasal discharge collected in a sterile container and sent for bacterial culture and antibiotic sensitivity. Get a Beta-2 Transferrin test on the fluid, if available, to rule out CSF (Cerebro-Spinal Fluid) A simple test is the 'Handerchief Test': Normal nasal secretions contain mucus which will stain and stiffen a soft handkerchief on drying, but CSF will not. The 'Halo' sign shows concentric rings. The 'Teapot' or 'Reservoir' sign is when there is a copious nasal discharge on bending forwards.

3. A bright yellow nasal discharge may be acute infection or allergy. If you have fever, start another antibiotic such as Augmentin.

4. I would like to see any CT Scans that may have been done in the past. You may share them here. The reason is to see if the previous two surgeries were adequate. This is because poor ventilation and drainage of your sinuses is the most important cause of Biofilm formation.There may be associated allergic, fungal and mucus related conditions. 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 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 bacteria share genetic material and may be genetically distinct from those that are grown in lab cultures. Hence they do not respond to the same antibiotics that they show sensitivity to in lab studies. Bacteria like E coli are notorious for antibiotic resistance and can cause other species like staph to become more resistant by exchange of genes and chemicals.

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. Supportive treatment such as mucolytics, anti allergics, anti fungals, steam inhalation and dental hygiene should be taken. Surgical debridement, removal and disruption of the Biofulm requires repeat or revision surgery.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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