Question:
I've got a post-nasal drip and frequent feeling of fatigue. 1 year ago
I had surgery - septum, concha-bullosa and ethmoid sinus, but since
then I still can't get rid of the problem.
My recent CT scan showed nothing wrong. Examination of bacteria present
in my nose revealed e.coli, klebsiella
oxytoca & pseudomonas - I took Cipro for 12 days and used Gentamycine
with inhalator and it helped a lot, but there are some distressing
symptoms that I'm still worried about. It usually begins with some very
intensive fatigue feeling and more mucus and ends with production of
some kind of characteristic mucus - looks like a jelly with some gray
stuff in it. After it happens I feel OK again like completely healthy
person. And the cycle returns again (usually 1 up to 3 times a day).
My questions are:
1. Are described symptoms a sign of getting better (sinuses clean of
some toxic stuff - like killed bacteria or fungi) or does it mean, that
my bacterial infection is getting worse (or at least not getting
better)?
2. I don't and didn't have any pain typical for sinus or teeth
problems, but is it possible that my condition is related to teeth? Is
teeth X-ray enough to diagnose this?
3. May it be fungus related? I know it's quite rare and my immune
system is OK, but my blood tests showed extreme high IgG antibodies
levels for Fusarium and medium for Candida.
Answer:
It's possible that you have an allergic fungal sinusitis, but that
creates the conditons for a bacterial sinusitis. I've had some of the
same bacteria cultured. You could have an infection in the bone. If
it doesn't clear up in a few days I would ask for a bone scan.
Do you mean they literally cultured bacteria from your nostrils, not
from your sinus ducts? If they did a nasal swab, that's worthless--the
bacteria in your nose can be totally different from those in your
sinuses. In fact, healthy people have plenty of "normal flora" in their
noses too.
A culture from your sinus ducts that reveals Pseudomonas, however, is
important.
Your sinusitis may just be aggravated by allergies. Have you been
tested for mold allergy with skin tests by a competent allergist? If
you have mold allergy, then it must be treated effectively in order for
your sinusitis to clear.
First of all, I disagree with Kathy that AFS is suggested here. AFS has
turned into a "default diagnosis" that is seized on whenever a patient
can't get rid of his sinusitis--if the sinusitis isn't cleared with
antibiotics and surgery, then "it must be" AFS. It shouldn't be. Mayo
Clinic, which first invented this AFS theory, has recently backed off on
it, they're not claiming it's the root cause of 95% of sinusitis
anymore. They have developed tests and examinations for that condition,
and without positive results from such tests there's no reason to assume
you have AFS.
They are now working on a brand-new theory (mucus biofilms), so Mayo
scientists will continue to have fun and be paid.
It's more believable that the infection has long since penetrated your
bone--that's where I'm at right now myself.
As to whether it has a dental origin, any competent dentist can X-ray
your upper teeth and see if you have any abscesses that are penetrating
into the maxillary sinuses. (You can have a tooth abscess without pain
symptoms--for a while. Then one fine day, it will suddenly explode with
pain. Been there, done that too.)
