Greetings ***** *****.
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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