I have had sinus pressure (above eye’s, either side of nose in cheek area, as well as sometimes back of head at neck) for over 3 months now. I’ve gone to the doctor numerous times. I am allergic to PCN (which they tell me is the best for this sort of thing). I have tried Doxycycline (3wks) Bactrim (1 wk, then started getting bronchitis) and 3 rounds of the Z-pak, the last dose also included a steriod to be taken for 5 days (gradually less and less). The Z-pak is the only one that I have gotten any relief from, usually after the 3rd day or so, however, after the initial 5 day dose ends (supposedly still in your system) I start to go downhill again, and the symptoms re-appear.
The last time the doctor gave me the Z-pak (2/23) he included a medrol dosepak (21 tabs). He said if I don’t feel miraculosly better by monday (2/27), he would start really doubting his initial speculation of a sinus infection. Well, miraculosly I did feel better, by Sunday even! For 4 days I have felt better than I have in 3 months! Now…come the 5th day, day after the Z-pak and steroid ended, the pressure is back! Full strength and in all three areas I described above.
Also, about 2 weeks ago, when my nose finally drained, it was a bright green color, and stayed that way until the Z-pak ended and my nose stopped draining completely.
My question is: Wouldn’t it be a sinus infection if the Z-pak with or without the steroids did improve my pressure even if temporary? Along with that and the discharge in a greenish color? I am really starting to think if I could only stay on the antiobiotic (z-pak) longer continually it will knock it out. I felt so good for 4 days!
I did have this problem last year, it took about 5 months to get rid of (only because they were mis-diagnosing it as bronchitis, etc.) but once I got on the z-pak a few rounds and probably the steroids it cleared up, until now.
Please help if you can…..starting to really doubt my doctor’s ability!!
Dr. Joshua’s Answer:
Antibiotic treatment of sinusitis is often initiated based on symptoms and physical examination. The drug of choice is Amoxicillin clavulanate. However, the role of antibiotics in sinusitis treatment is not clear.
In your case, where recurrent sinusitis is the problem, a sinus X-ray is recommended to confirm the diagnosis. We must be certain that you have sinusitis and not something else that’s causing the symptoms. If the X-ray shows clear findings, a sinus puncture is recommended. An ear, nose and throat specialist should be consulted to rule out surgically treatable anatomical predisposition..
A common cause for recurrent sinusitis is allergy. Systemic steroids (medrol) are not usually recommended - there is no evidence of benefit. However, your doctor must have had his/her reasons to prescribe it. It is not my intention to second-guess your doctor. If allergy is present, nasal corticosteroid treatment may be beneficial.
In summary, the diagnosis must be verified - X-ray and puncture. Puncture is also an effective treatment - surgical treatment - sinusitis is essentially a surgical infection (abscess). Also, puncture and drainage will reveal the offending micro-organism, which will help select the right antibiotic.
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