Suggest treatment for sinus infection

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Posted on Mon, 3 Jul 2017 in Ear, Nose and Throat Problems
Question: Hello!
Question I have about a possible sinus infection (that I didn't know I had). I need to mention as well that I have been battling high viral loads of the Epstein Barr Virus for nearly a year now. It started with a reactivated case that became acute, brief month of starting to feel better followed by EBV titers showing a new infection and latency. I throw that in there because of its strong ties to a very rare form of cancer as I am sure you are familiar with Nasopharengyl.

I had a brain MRI completed 6/13/17 to check for potential brain related causes for the Peripheral Neuropathy symptoms I've experienced as of late. Doctor called to confirm no lesions etc... However on my MRI there is a large black hole that would put location left Maxillary area (sorry if I am incorrect, photo provided). It looks like maybe a bad sinus infection? I have no accompanying symptoms to go with this, no running nose, sneezing, itching or drainage. (My doctor didn't mention this area at all, and I was too afraid to speak up and ask, much easier to do behind a computer screen).

I was surprised when I looked into my nose to see that I was swollen in there. Last CBC was normal and it just so happens I finished a full course of Ciprofloxacin 500mg 2X daily on the same day of MRI. From what I gather this type of med isn't classically used for sinus infection.

I know it is not cancer of course but I need backup... Does that look like a sinus infection and what antibiotic should I anticipate the doctor prescribing? It would be nice to get your opinion before I call my doctor to ask why no one thought it would be kind to point this out to me.
doctor
Answered by Dr. Priyanka Aggarwal 2 hours later
Brief Answer:
Chronic sinusitis

Detailed Answer:
Hi
Welcome to Healthcare Magic and thanks for putting up the query
Your MRI PICTURES show that you have maxillary sinusitis. The picture of nose has nothing abnormal. The swelling is nasal mucosa.
In the MRI PICTURES there is no sign of any carcinoma but it would be better if you get an endoscopic examination of nasal cavities done to rule out any other nasal pathology.
You should visit an ENT SPECIALIST and get treatment for maxillary sinusitis. It can be cleaned surgically by FESS I.e. endoscopic sinus surgery.
Start taking tablet levocetrizine plus montelukast once daily and nasal spray twice daily for 10 days.
All the medicines I have prescribed will be available at prescription only.
Any further questions are always welcome.
Thanks and regards
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Priyanka Aggarwal 34 minutes later
Doctor Aggarwal,

Thank you kindly for the information! Just one additional question, you mentioned surgical procedure FESS - in your opinion based on the information I provided does this look like a bad case? I guess what I am saying, is given the recent course of antibiotics I did take (which isn't generally prescribed for sinus infection but should bear some value to reducing infection but did not) is that what swayed your opinion towards this procedure?

The reason I ask that is not to be insulting to your talents, it is due to financial matters. Specialist with my insurance are much more expensive rather than seeing a family doctor or nurse practitioner.

Would it be wise of me to try and save money and ask my family doctor for those medicines, or should I just pay the money and see a specialist in your same field of medicine?
I am sorry as I just realized I asked more than one last question. :-D
doctor
Answered by Dr. Priyanka Aggarwal 2 hours later
Brief Answer:
Chronic sinusitis

Detailed Answer:
Hi
I understand your concerns and any questions are always welcome.
I have suggested as per the MRI PICTURES.
If you can't go to an ENT SPECIALIST at the moment you can take some medicines that I can prescribe as well but it is certain that best is to visit an ENT SPECIALIST.
You can take a combination of levocetrizine and phenylepherine twice daily and fluricasone nasal spray twice daily for a week.
All the medicines I have prescribed will be available at prescription only.
The medicines can only alleviate symptoms.
If possible please send me your MORE MRI PICTURES as the one you sent are not enough.
Wish you get well soon.
Thanks and regards
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Priyanka Aggarwal 1 hour later
Thank you so very much for response!

I have attached images, I inverted coloring on some and added measurements on others. I am not sure what I am doing but I hope that you find this useful. I kept them in sequential order.

It is noted that T1 images and T2 images captured size of the infection differently. I wondered if this was due to some anatomical change within the center of this storm.

Please let me know if these were satisfactory.

Thank you!I attached 15 images but I do not see them all, please let me know if you do not receive all 15.

Just wanted to mention out of curiosity I inserted my finger in my nose and massaged the area - it produced some drainage down my throat, and a light burning sensation. Mild headache but after a short time all symptoms dissipated without medicine intervention.

(I have been experiencing dizziness, pain if my head is slightly tilted down but I move my eyes upward, blurred vision, and headaches but more in the back of head like pressure. I just assumed these symptoms were either EBV related or Cypro antibiotic related, now I am not so sure.)


Thank you again!
doctor
Answered by Dr. Priyanka Aggarwal 14 minutes later
Brief Answer:
Chronic sinusitis

Detailed Answer:
Hi
I have received all the pictures.
there is a mass in the left maxillary sinusitis with deviation in nasal septum.
Please tell me do you have any problem with your left upper jaw or hard palate?
Any swelling or any discharge from there?
The sinus mass can't be commented upon without examination. Take the medicines as prescribed.
Don't poke into your nose as the problem is in sinus and you can't palate anything there. The symptoms you developed on poking nose are just normal that happens when nasal mucosa is irritated.
Attach the reports of this MRI also for reference.
Thanks for the information.
Regards
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Priyanka Aggarwal 1 hour later
I will collect the MRI notes from the hospital later this morning, I am also interested to read it. I barely finished highschool and noticed on my own it didnt look normal. I told tech day of test to provide me copy so I could take to Neuro but I took home to look it over...No drainage that I have noticed. However these symptoms I thought were related to PN or EBV include blurred vision, eye pain, pain if my head is tilted down but I move eyes up, just in last 2 weeks occasionally when I swallow a slow moving electric pain from my tonsil area shoots up into my brain (my right your left) and sometimes down to my upper ribs.

In a moment of crying very recent I tried to swallow my spit down and it was so hard to swallow. Felt like a lump, it was odd so I kept swallowing to feel it somemore. Once I calmed down it no longer felt that way.Hello image of doctors findings attached... what does it mean?
doctor
Answered by Dr. Priyanka Aggarwal 9 hours later
Brief Answer:
Chronic sinusitis with deviation in nasal septum

Detailed Answer:
Hi
Thanks for the information.
Your report comments only on the nasal septum that it is deviated. Your symptoms can be explained by this only.
The problem of inability to swallow saliva on crying is a physiological effects of emotions. It is not due to any pathology.
The other symptoms are not related to EBV INFECTION.
The occasional electrical impulse is due to overstimulation of nerve fibres that also is just physiological.
The maxillary sinus swelling has not been mentioned in the report. my advise is you should follow the prescription as advised and visit an ENT SPECIALIST when possible.
Take care
Thanks and regards

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

ENT Specialist

Practicing since :2008

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