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Suffer recurrent sinus infections. Took interferon treatment for stage 3 melanoma. Suggestions?

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ENT Specialist
Practicing since : 1991
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Hi-my name is XXXXX. I am a 35 year old female and I struggle with recurrent sinus infections. I have always been more prone to getting sick. This became worse after I completed a year of interferon treatment for stage 3 melanoma. In the past two years, I have undergone three sinus surgeries and had my tonsils and adenoids removed. I still get infections and can only be off abx for about 2 weeks then I am sick again. my cultures show a variety of bacteria, from strep to staph to strep pnemo and now ecoli. I am currently on keflex for ten days for the ecoli sinus infection. Also I have low total igg levels and low igg 3 levels. my Dr is trying to get me ivig treatment. However the insurance company keeps denying it and we are in appeals. Any ideas, suggestions, or insights? Do you think I am on the right track? also, how would I get a ecoli infection in my sinuses? thanks!
Posted Mon, 21 Oct 2013 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 8 hours later
Brief Answer:
Reviw of CT images, Biofilm formation, Sinus wash

Detailed Answer:

Thank you for your query.

1. I would like to review any CT Scan images, if you can upload them here.

2. The cause of your problems may be Biofilm formation in your sinuses. There may be associated allergic, fungal and mucus related conditions.

3. 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.

4. 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. Poor ventilation and drainage of your sinuses is the most important cause of Biofilm formation. Inadequate surgery or adhesions, scar tissue post surgery may also lead to this.

6. 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.

7. You may add an antibiotic like tetracycline or chloramphenicol. However this should be done under medical supervision. You may try higher generation antibiotics such as cefprozil or ceftriaxone, again to be administered only by your local doctors. You should draw their attention to Biofilm formation, which is a relatively new concept.

8. 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.

9. Your immunosuppression must also be treated.

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

Above answer was peer-reviewed by
Follow-up: Suffer recurrent sinus infections. Took interferon treatment for stage 3 melanoma. Suggestions? 13 days later
hi thank you for your response. I don't have any updated ct scans. they were all done before my last surgery. how do I get tested for this biofilm? I completed the round of abx prescribed for the last infection, keflex, but I feel like the infection is not cleared up. I already irrigate with the neti pot, get regular dental cleanings, take zyrtec and flonase daily. my Dr is trying to get ivig approved but insurance is being difficult. Thank you!
Answered by Dr. Sumit Bhatti 18 hours later
Brief Answer:
Latest CT Scan.

Detailed Answer:

Thank you for writing back.

1. Arranging for a latest CT Scan will help in deciding the further management.

2. Request for a nasal endoscopy and culture of sinus washes.

3. Discuss the above suggestions with your doctors.

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

Above answer was peer-reviewed by
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