Greetings XXXXX XXXXX.Your symptoms and last 2 month history are suggestive of chronic sinusitis. A coronal CT of the sinuses and/or fiberoptic nasal endoscopy is diagnostic for it. Some physician may recommend nasal smear also to differential the allergy and infection. The aim of treatment is; relieve the obstruction, treatment of the infection, if present, thinning the mucus, and opening the sinus. Following would be the treatment protocol;
1) Nasal steroid; decrease inflammation and open up obstruction.
2) Oral decongestants such as pseudoephedrine are often helpful.
3) Topical decongestant for short duration.
5) Steam vaporizer
6) Eucalyptus oil may help
7) Nasal saline irrigation
8) Vitamin C
9) Antibiotics course again; only if nasal culture is positive and there are signs in CT scan.
For treating it naturally; steam inhalation, nasal saline water (salt water) irrigation (can be done by Neti-pot), Vitamin C, Eucalyptus oil inhalation can be done. Following can increase the body immunity so help in overcoming the sinus infection;
1) Omega 3; Fish oil capsule and flaxseed oil capsule.
2) Ginkgo Biloba
3) Zinc 30 mg.
You may also be looked for GERD, which has increasingly been implicated in causing or exacerbating chronic sinusitis. The exact relationships and mechanisms are presently a matter of speculation, though.
The diagnostic and management protocol for the chronic cough is as following;
1) we will do a chest x-ray first; which has been done for you and is normal
2) pulmonary function tests or spirometry is the second step
3) starting of empiric therapy for postnasal drip, asthma, or gastroesophageal reflux. The GERD can be sometimes uncontrolled despite the medications and this will need further evaluation in the form of esophageal manometry (food pipe pressure study) and pH study of the food pipe (esophagus).
4) methacholine challenge testing to evaluate for airway hyperreactivity; done for the bronchospasm / bronchial asthma.
5) sputum or phlegm examination for eosinophils or empiric trial of corticosteroids for eosinophilic bronchitis.
If despite these measures, cough persists we would consider further investigations like esophagoscopy, 24-hour pH probe monitoring, high-resolution chest CT, or bronchoscopy.
The common causes of chronic cough are postnasal drip (also called upper airway cough syndrome), asthma (in your case, asthma medications are not giving you relief so this can be ruled out), and gastroesophageal reflux disease (GERD). These three causes are responsible for up to 90 percent of all cases of chronic cough. Less common causes include infections, medications, and chronic lung diseases. Another common cause of chronic cough is nonasthmatic eosinophilic bronchitis.Following causes should be considered for the cough;
1) Upper airway cough syndrome; they comprise of vasomotor rhinitis; acute nasopharyngitis; and sinusitis. The treatment is by steroid nasal spray or nasal antihistamine. Sinusitis may need antibiotic like trimethoprim-sulfamethoxazole or cefuroxime.
2) Cough variant asthma; this will require bronchodilator medications used in asthma or steroid inhalers.
3) Gastroesophageal reflux disease (GERD); treatment is by avoidance of reflux-inducing foods (fatty foods, chocolate), eating five meals a day without snacking, avoidance of meals for two to three hours before lying down (except for medications), elevation of the head of the bed and an H2 antagonist or a proton pump inhibitor.
4) Postnasal drip; would need antihistamines and inhaled ipratropium bromide.
5) Non specific cough; Dextromethorphan and/or codeine can be used.
Please feel free for your follow up questions.
I would be happy to assist you further, if you need any more information.
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I do have an esophagial hernia, but these symptoms have all started since I got this darn cold. Always feels like something is stuck in my throat. So you think I should go back to my ENT?
Also Dr. Do you think this has all been a virus and the zpac and Augmentin 875 didn't help because of this? If I stay away from antibiotics, can I beat this thing? My parents both lived to ripe old ages. has the antibiotics I took made this thing worse? If I get well, I'm going to send you a nice bonus
Hello and welcome, John.You should discuss this with your ENT specialist; especially if he/she may not be aware (or just forgot about it) of the esophageal hernia (Hiatal hernia) which can cause GERD and the chronic cough. The chronic cough has usually three origins, as we had discussed;
a) Chronic sinusitis
b) Upper respiratory tract; chronic bronchitis
Lungs; infections, chronic obstructive pulmonary disease or restrictive lung diseases are the other causes, which usually occur in older age group.
Another Specialist to see is pulmonolgist. Following investigations should be done, if not already been done;
1) Pulmonary function tests
2) CT scan of sinuses
3) HRCT of the chest
Chronic bronchitis and Bronchial asthma are the other common causes. Usually they have allergic origins. Immunoglobulins IgE, total eosinophil counts and vacuolated eosinophil counts point towards allergic phenomenon. They are treated for by inhalation steroids. A consideration of bronchodilators and corticosteroids through nebulizer should also be done.
With the above measures, breathing exercises, and chest physical therapy should be beneficial.
One very common cause for the cough is gastroesophageal reflux disease in her age group. This should be considered, if respiratory tract seems to be not involved. Investigations like 24 hours pH estimation, esophageal manometry and upper gastrointestinal endoscopy would be contemplated.
Also discuss about Post nasal drip, with your doctor. Newer antiallergic medications like Allegra are usually not very effective for it. Taking older generation anti-histamine Cyproheptadine or Chlorpheniramine Maleate would be more helpful, though they may cause slight drowsiness (both are prescription products).
Symptoms of postnasal drip are frequent nasal discharge, a sensation of liquid dripping into the back of the throat, and frequent throat clearing. However, postnasal drip may also be "silent," so that the absence of these symptoms does not necessarily rule out the diagnosis. Because the symptoms and signs of postnasal drip are nonspecific, there are no definitive criteria for its diagnosis, and it is ultimately the response to therapy that secures the diagnosis. When an alternative specific cause for cough is not apparent, empiric therapy of postnasal drip should be attempted before embarking on an extensive diagnostic work-up for other causes.
GERD is treated as following;
1) antacids; Maalox
2) acid blocker; Prilosec
3) loosing weight, if overweight.
4) avoiding alcohol, citrus fruits and juices, chocolate, and tomato based products
5) avoiding large meals. Eat 5 small meals in a day.
6) wait three hours after the meal before you sleep.
7) elevate head end of the bed by 8 inches.
Antibiotics occasionally may increase the gastroesophageal reflux disease (GERD).
It is privilege assisting you.
I am taking 500mg of metformin daily for Diabetes too
There is no chance of this being meningitis is there?
Do you know a competent ENT in the Miami, FL area? I'm not happy with mine. I have excellent insurance.
you have been a big help Dr. How can I keep in touch with you?
Last question doc: I this is not going to kill me is it because Im starting to get worried will this eventually go away by itself?
are you still there doc?
Thank you and God bless you.
i will send bonus when I recover and I will tell my friend Sania Mirza how you helped me. she is the beautful and talented tennis player from India.