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Suggest treatment for sinus infection

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General & Family Physician
Practicing since : 1991
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I am a male 47. I have had a pressure from the back of my head to the forehead since Christmas.
I not congested- I can breath through nose though dry and tight.
When I do that pressure builds.

Whether Siting standing walking or lying down this strange and debilitating pressure remains. It is absolutely exhausting

My pc today said it could possibly be a sinus infection but my temperature remains s steady 96.3
I am confused, frustrated and concerned.
Sat, 9 Jun 2018 in Headache and Migraines
Answered by Dr. Bonnie Berger-Durnbaugh 1 hour later
Brief Answer:
Questions so that I can advise

Detailed Answer:
Hello and welcome,

You write that the feeling of pressure increases when you breathe through your nose and that it is a tight feeling to breathe through your nose.

Did your pc examine you today and find that it appeared to be an infection or was this conjecture based on your symptoms?

By pc, do you mean doctor, or a physician's assistant?

Have you had problems with sinus infections before and do you smoke cigarettes?

Also, I'm wondering if you can clarify: you say you are not congested but that it is tight to breathe through your nose? Thanks

I'll write more after I hear back, but a safe thing you can try is to irrigate your sinuses with saline 1-2 x/day, either with a nettipot, or with pre-made saline such as SimplySaline.

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Follow-up: Suggest treatment for sinus infection 10 minutes later
Thank you for the reply.

My primary care spoke to me on the phone only. We had met for an exam only a week before Christmas when this pressure was not there. It was only by phone consultation and describing the symptoms that he made this assumption/diagnosis. He did ask me while on the phone to place my head between my knees and asked me what pressure I felt. I felt pressure on my cheek bones in my drawer in the back of my eyes.

He advised me to do the same as you have while on the phone. So I bought a Flonase this evening. With the Saline solution, how long Do they take effect?

I have a very dry cough. I have tried Mucinex for over a week with no change. So, I assume that didn’t have a cold.

I never had a sinus infection before. I am prone to bronchitis. This thing makes me completely disconnected with people, and daily tasks, I literally can’t think I have a brain fog.

Would be wise to get an x-ray? And if so, What kind? Head? Sinus? Lungs?

Thank you
Answered by Dr. Bonnie Berger-Durnbaugh 1 hour later
Brief Answer:

Detailed Answer:
Thanks for the additional information.

The Flonase can take a week to start working maximally, but you may see some improvement after a couple of days. Flonase is a steroid nasal spray (fluticasone) which can decrease inflammation.

The nasal saline shouldn't be used at the same time as the Flonase because of wash out so space them out by at least an hour or more if you can. The saline rinses out mucus and germs, hydrates the tissues, and shrinks swelling. Saline is safe to use multiple times as needed.

If these measures don't work, the next step would be to go in to see your doctor. Not a PA or NP but a real doctor. He may want to try a course of antibiotic, or, if convinced that there isn't a bacterial infection, then a head or sinus CT. MRI can be used for this too, but there is less data about it's use for the evaluation of sinuses - it's advantage though is that it doesn't use radiation.

When people have ongoing sinus infections, an exam of the throat usually shows something called "cobblestoning". The mucus membranes of the back of the throat develop changes from the drainage from the sinuses (which resolve after the infection clears). Often there is also drainage on the back of the throat too.

If there are no throat signs of infection from the sinuses, and an exam of the nose is normal too, then sinus infection may not be the thing. In that case, I recommend you have an MRI of the head. MRI gives very good, detailed information about blood vessels, mucus membranes and other soft tissue.

So - try the Flonase and nasal saline rinses for 1 week. In the meantime schedule an appointment to see the doctor, which you can cancel if you note relief from the steroid spray and saline. Then see the doctor, and find out if there are signs of sinus infection. If there are - antibiotic is appropriate. If there are not - then an MRI of the head is next.

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