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Old 10-18-2008, 03:54 PM   #1
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how would you know if you had fungal sinsuitis?

ive already had 2 sinus surgeries in my life

im 25, and have been on allergy shots since 8 yrs old.

ive done the zyrtec, flonase, nasonex, you name it.....so whenenver i have an infection i usually end up on antibiotics.

right now im on levaquin and augentin together.

eventually im going to become antibiotic resistant, and thats going to be wonderful.

does this sound like fungal sinusitis or what, and how would i found out.....im sooo desperate for a solution.

 
Old 10-18-2008, 06:21 PM   #2
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Re: how would u know if u had fungal sinsuitis

My husband was just diagnosed with a culture - one before the surgery he just had and one during the surgery from what they removed. Still waiting on results of exactly what type of fungus/mold it is. This is his 3rd sinus surgery and from what we are reading, its almost impossible to get rid of - ask for a culture.

 
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Old 10-18-2008, 07:44 PM   #3
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Re: how would u know if u had fungal sinsuitis

how confident are They about This Surgery?

 
Old 10-19-2008, 06:39 AM   #4
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Re: how would u know if u had fungal sinsuitis

Bebe1983-

There's no easy answer to your question.

Fungal sinusitis is an issue/question that has caused a lot of discussion in the ENT community over the last 8 years. In 1999 a group of researchers at the Mayo Clinic found evidence of fungus in the sinuses of 96% of the people with chronic sinusitis that they tested but they found that almost as many people without chronic sinusitis showed evidence of fungus in their sinuses.

The researchers hypothesized that fungal sinusitis is much more common than anyone thought. As their results were refined it seemed more likely that it wasn't just the presence of fungus that led to chronic sinusitis (since it was present in people with and without the disease), but the way some people's bodies react to the presence of fungus (specifically the release of cells called eosinophils that attack the fungus and, in the process, cause inflammation in the lining of the sinuses, which leads to chronic sinusitis.

Today there are 3 kinds of fungal sinusitis that are commonly recognized. The first two, Invasive Fungal Sinusitis (which typically affects people whose immune systems have been compromised) and Fungus Balls (which typically involves thick balls of fungus-filled mucus that have to be removed surgically) are fairly rare and would typically have been easily identified by the doctors who performed your surgery.

The third, Allergic Fungal Sinusitis (or Eosinophilic Fungal Sinusitis) is more common but there is no single test for it. Doctors look for a combination of symptoms, including: Positive skin test for mold/fungus allergy, The presence of nasal polyps, The presence of eosinophils in mucus secretions, and a positive culture showing fungus in your sinuses.

Patients with Allergic Fungal Sinusitis are being treated with an irrigation solution of Amphotericin B (an antifungal medication) in addition to the normal treatment regimen for chronic sinusitis. Amphotericin B can be very toxic when taken internally but it doesn't have the toxic side effects when used topically, and has shown promise in some patients with Allergic Fungal Sinusitis.

So, back to your initial question, if you have: A positive skin test for mold/fungus allergy, Nasal polyps, The presence of eosinophils in mucus secretions, and a positive culture showing fungus in your sinuses, you may well have fungal sinusitis and should ask your doctor about trying irrigation with Amphotericin B to see if it helps.

In addition to that (and the shots, daily antihistamine/Nasonex you're already using), you should be on a sinusitis management regimen that includes daily saline irrigation with a SinusRinse bottle, neti pot or other irrigation method. You might also ask your doctor about Singulair or another leukotriene inhibitor - they seem to help with the inflammation, particularly if you've ever had nasal polyps. You also don't mention if they've had you on short courses of oral prednisone which can help reduce the swelling and get your sinuses functioning normally again.

One final thought for you on antibiotic resistance. People don't become antibiotic resistant, bacteria do. As long as you're taking the medications correctly you may never encounter a bacteria that is antibiotic resistant, and getting your sinusitis sorted out will go a long way toward keeping the antibiotics to a minimum.

 
Old 10-19-2008, 10:42 AM   #5
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Re: how would u know if u had fungal sinsuitis

Quote:
Originally Posted by gcsmithjr View Post
Bebe1983-

There's no easy answer to your question.

Fungal sinusitis is an issue/question that has caused a lot of discussion in the ENT community over the last 8 years. In 1999 a group of researchers at the Mayo Clinic found evidence of fungus in the sinuses of 96% of the people with chronic sinusitis that they tested but they found that almost as many people without chronic sinusitis showed evidence of fungus in their sinuses.

The researchers hypothesized that fungal sinusitis is much more common than anyone thought. As their results were refined it seemed more likely that it wasn't just the presence of fungus that led to chronic sinusitis (since it was present in people with and without the disease), but the way some people's bodies react to the presence of fungus (specifically the release of cells called eosinophils that attack the fungus and, in the process, cause inflammation in the lining of the sinuses, which leads to chronic sinusitis.

Today there are 3 kinds of fungal sinusitis that are commonly recognized. The first two, Invasive Fungal Sinusitis (which typically affects people whose immune systems have been compromised) and Fungus Balls (which typically involves thick balls of fungus-filled mucus that have to be removed surgically) are fairly rare and would typically have been easily identified by the doctors who performed your surgery.

The third, Allergic Fungal Sinusitis (or Eosinophilic Fungal Sinusitis) is more common but there is no single test for it. Doctors look for a combination of symptoms, including: Positive skin test for mold/fungus allergy, The presence of nasal polyps, The presence of eosinophils in mucus secretions, and a positive culture showing fungus in your sinuses.

Patients with Allergic Fungal Sinusitis are being treated with an irrigation solution of Amphotericin B (an antifungal medication) in addition to the normal treatment regimen for chronic sinusitis. Amphotericin B can be very toxic when taken internally but it doesn't have the toxic side effects when used topically, and has shown promise in some patients with Allergic Fungal Sinusitis.

So, back to your initial question, if you have: A positive skin test for mold/fungus allergy, Nasal polyps, The presence of eosinophils in mucus secretions, and a positive culture showing fungus in your sinuses, you may well have fungal sinusitis and should ask your doctor about trying irrigation with Amphotericin B to see if it helps.

In addition to that (and the shots, daily antihistamine/Nasonex you're already using), you should be on a sinusitis management regimen that includes daily saline irrigation with a SinusRinse bottle, neti pot or other irrigation method. You might also ask your doctor about Singulair or another leukotriene inhibitor - they seem to help with the inflammation, particularly if you've ever had nasal polyps. You also don't mention if they've had you on short courses of oral prednisone which can help reduce the swelling and get your sinuses functioning normally again.

One final thought for you on antibiotic resistance. People don't become antibiotic resistant, bacteria do. As long as you're taking the medications correctly you may never encounter a bacteria that is antibiotic resistant, and getting your sinusitis sorted out will go a long way toward keeping the antibiotics to a minimum.
thank u for your thorough response. in addition, i am also taking prednisone and got a steroid shot yesterday since my sinuses are very inflammed.

i am also using neil med's sinus rinse everyday at least 3 times a day. but my inflammation is so bad that it hardly rinses out anything. ive just started using grapeseed extract in The solution bc i heard it was good for fungi.

ive had two sinus surgeries in 3 years, and had one of the best surgeons in my area, but ive recently moved. the one sinus on the right side is always The worst too, always more plugged Up and having more pressure Than the left side. every single day that side will give me agony, but will usually resolve With 4 ibproperin and afrin. but i can usually Tell when an infection will pop up cause ill be taking painkillers for about a week and will appear swollen. i think i might need another surgery....sigh

ive also been finding That hiv in pateints can cause recurrent fungal sinus infections, so i might need to get tested to put that to rest.

 
Old 10-20-2008, 04:01 AM   #6
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Re: how would you know if you had fungal sinsuitis?

Given all that you're dealing with I'd recommend you find an ENT at a University or Teaching hospital who specializes in chronic sinusitis - more surgery may not help much until you figure out what's causing all of the inflammation. Sounds like you're really suffering which is such a drag.

 
Old 10-20-2008, 01:35 PM   #7
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Re: how would you know if you had fungal sinsuitis?

Quote:
Originally Posted by gcsmithjr View Post
Given all that you're dealing with I'd recommend you find an ENT at a University or Teaching hospital who specializes in chronic sinusitis - more surgery may not help much until you figure out what's causing all of the inflammation. Sounds like you're really suffering which is such a drag.
i have been diagnosed with anxiety disorder. maybe i just need to see a psychiatrist.

the doctor told me today that my sinuses are not draining for some reason. im on augmentum and levaquin. they took an xray, not a ct, and it revealed lots of pus and inflammation. i dont Think it showed any polyps or absesses.

i have to wait another week before i can get the ct Scan, for insurnace purposes.

as far as my allergies go, they gave me singular to Take. ill have to admit Though, i stopped taking my flonase for some time bc of the side affects im concerned about....maybe thats where i went wrong, but im on allergy shots...it's ridiculous i have to take all of these meds.

 
Old 10-21-2008, 03:32 AM   #8
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Re: how would you know if you had fungal sinsuitis?

Quote:
i stopped taking my flonase for some time bc of the side affects im concerned about
What side effects are you concerned about? Flonase is very safe and effective and has few side effects (certainly fewer than oral steroids).

Quote:
they gave me singular to Take...im on allergy shots...it's ridiculous i have to take all of these meds.
Are you still taking an antihistamine (and maybe a decongestant like 12-hour sudafed)? Shots and Singulair should help but don't usually replace an antihistamine.

I know it's not fun to take all of those medications but it's a heck of a lot better than having additional surgery.

 
Old 10-21-2008, 01:18 PM   #9
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Re: how would you know if you had fungal sinsuitis?

Quote:
Originally Posted by gcsmithjr View Post
What side effects are you concerned about? Flonase is very safe and effective and has few side effects (certainly fewer than oral steroids).



Are you still taking an antihistamine (and maybe a decongestant like 12-hour sudafed)? Shots and Singulair should help but don't usually replace an antihistamine.

I know it's not fun to take all of those medications but it's a heck of a lot better than having additional surgery.
no, my allergist told me taking an antihistamine would only dry out my sinuses even more....bad choice for me. i just started takig singulair, so we'll see.

i just dont understand thought.....anytime i have a sinus infection i see green....drainage that is. as much as ive been irrigating, nothing has come out. it's quite scary actually that there is so much inflammation that i cant get any drainage. it's never been this bad for me.

i know you say the flonase is pretty Safe and all, but i have to admit That i think it could possibly do more harm Than good...only bc it is a cortiosteriod and that is whats created naturally in our bodies during the stress response. i know stress can exacerbate allergies, and now our adrenals are working overtime, and that can reduce thyroid function, and there u go with the symptoms.

but at This point im so bad, i just dont care...ill take anything as long as i feel i Can function.

oh yea, do u know Anything about having your adnoids out.....my doc was Saying i might need that, but would that do any good for my sinuses?

 
Old 10-21-2008, 02:55 PM   #10
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Re: how would you know if you had fungal sinsuitis?

Quote:
my allergist told me taking an antihistamine would only dry out my sinuses even more....bad choice for me. i just started taking singulair
Just remember that Singulair is not an antihistamine. It helps block the release of leukotrienes which cause inflammation as part of an allergic reaction but isn't all that effective with allergies (it's more effective with asthma which is an inflammatory disease). You might try taking Claritin - it's probably the least drying of the antihistamines, and if you have allergies that are severe enough that you're getting shots, an antihistamine can't really hurt.

Quote:
flonase is pretty Safe and all, but i have to admit That i think it could possibly do more harm Than good
Because it's administered topically, the amount of Flonase that ever gets into your bloodstream is tiny (less than 2% according to clinical trials). For most people that translates to absolutely no steroids actually getting into your bloodstream. It's certainly much safer to use the Flonase than to have your symptoms get out of control and need oral steroids.

Quote:
oh yea, do u know Anything about having your adnoids out.....my doc was Saying i might need that, but would that do any good for my sinuses?
It does help some people. The adenoids can become inflamed and block the drainage pathway from the sinuses to the throat, causing mucus to get trapped and harbor an infection. Removing the adenoids can help your sinuses drain better which could help alleviate your infections.

 
Old 10-22-2008, 01:15 PM   #11
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Re: how would you know if you had fungal sinsuitis?

Quote:
Originally Posted by gcsmithjr View Post
Just remember that Singulair is not an antihistamine. It helps block the release of leukotrienes which cause inflammation as part of an allergic reaction but isn't all that effective with allergies (it's more effective with asthma which is an inflammatory disease). You might try taking Claritin - it's probably the least drying of the antihistamines, and if you have allergies that are severe enough that you're getting shots, an antihistamine can't really hurt.



Because it's administered topically, the amount of Flonase that ever gets into your bloodstream is tiny (less than 2% according to clinical trials). For most people that translates to absolutely no steroids actually getting into your bloodstream. It's certainly much safer to use the Flonase than to have your symptoms get out of control and need oral steroids.



It does help some people. The adenoids can become inflamed and block the drainage pathway from the sinuses to the throat, causing mucus to get trapped and harbor an infection. Removing the adenoids can help your sinuses drain better which could help alleviate your infections.

i wonder if i should go off the singulair....my allergist never prescribed it, only the doctor at the urgent care center. my allergist always said the antihistamines would be too Drying for my sinuses.

i also wonder if going off my flonase for many months significantly contributed to this sinus inflammation.....

i thought my allergy shots, alone, would help me. i didnt think i needed all the other crap in my system.

one other thing, as far as the neil meds sinus rinse goes, i Was told i doesnt even get into the sinus cavities, just The nasal cavity....would the hydropulse irrigation system be any better? the thing i like about neil meds is that i can squeeze the solution more forcefully. but it's not pushing out any green gunk or anything,...it Really Sucks

 
Old 10-22-2008, 03:58 PM   #12
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Re: how would you know if you had fungal sinsuitis?

Quote:
i wonder if i should go off the singulair
It might help with the inflammation so I'd stick with it for a few weeks to see if you think it helps.

Quote:
my allergist always said the antihistamines would be too Drying for my sinuses.
I'm very surprised by that. Yes, they can be drying (although the newer ones like Claritin and Zyrtec aren't as drying as some of the older ones), but the release of histamines during an allergic reaction causes an inflammation in the mucus membranes in your nose. That's why some people swell up if they eat something they're allergic to. Antihistamines stop (or minimize) this reaction which helps minimize the inflammation in your sinuses. When you're struggling with allergies, antihistamines work best when taken every day so that the histamine never gets released, the inflammation never starts, and you don't end up being miserable.

Quote:
i also wonder if going off my flonase for many months significantly contributed to this sinus inflammation
I suspect that it did (after all, Flonase is primarily an anti-inflammatory).

Quote:
i thought my allergy shots, alone, would help me
They take time, and it usually works best to slowly wean yourself off of medication once the shots are working and your symptoms have diminished. Many people still need some medical therapy in addition to the shots.

Quote:
as far as the neil meds sinus rinse goes, i Was told i doesnt even get into the sinus cavities, just The nasal cavity
I don't know who told you that but it's absolutely not true (think about the volume of water in that NeilMed bottle compared to the size of your nose, and keep in mind that the entrances to the maxillary and ethmoid sinuses are right inside your nasal cavity, if it's not getting into your sinuses, where is it all going?). If you want to prove to yourself that it does actually get into your sinuses try irrigating with cold water (once!) - you'll be able to feel it getting up into your frontal sinuses and into your maxillary sinuses.

Quote:
would the hydropulse irrigation system be any better?
I prefer the NeilMed bottle for the same reason you do - you can use more force to get the liquid into the sinus cavities. The main reason some people give for using the hydropulse system is that the pulsating action more closely matches the natural rhythm of the cilia in your nose, but it's also messier, takes longer and is a little more complicated (and it's expensive). Most of the ENTs that I know are recommending the SinusRinse bottles.

Quote:
i didnt think i needed all the other crap in my system.
I completely understand but it's better than more surgery. I'd recommend that you keep taking the Singulair, start back on the Flonase, and try taking a Claritin every day for two weeks to see if you feel better and are less congested. If things improve then you can try stopping one med at a time to see if you can decrease the number of things you're taking, but it sounds like you're pretty miserable right now and I suspect that you'll feel a lot better once you get this under control.

Last edited by gcsjr; 10-22-2008 at 04:00 PM.

 
Old 10-24-2008, 10:28 PM   #13
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Re: how would you know if you had fungal sinsuitis?

Quote:
Originally Posted by gcsmithjr View Post
It might help with the inflammation so I'd stick with it for a few weeks to see if you think it helps.



I'm very surprised by that. Yes, they can be drying (although the newer ones like Claritin and Zyrtec aren't as drying as some of the older ones), but the release of histamines during an allergic reaction causes an inflammation in the mucus membranes in your nose. That's why some people swell up if they eat something they're allergic to. Antihistamines stop (or minimize) this reaction which helps minimize the inflammation in your sinuses. When you're struggling with allergies, antihistamines work best when taken every day so that the histamine never gets released, the inflammation never starts, and you don't end up being miserable.



I suspect that it did (after all, Flonase is primarily an anti-inflammatory).



They take time, and it usually works best to slowly wean yourself off of medication once the shots are working and your symptoms have diminished. Many people still need some medical therapy in addition to the shots.



I don't know who told you that but it's absolutely not true (think about the volume of water in that NeilMed bottle compared to the size of your nose, and keep in mind that the entrances to the maxillary and ethmoid sinuses are right inside your nasal cavity, if it's not getting into your sinuses, where is it all going?). If you want to prove to yourself that it does actually get into your sinuses try irrigating with cold water (once!) - you'll be able to feel it getting up into your frontal sinuses and into your maxillary sinuses.



I prefer the NeilMed bottle for the same reason you do - you can use more force to get the liquid into the sinus cavities. The main reason some people give for using the hydropulse system is that the pulsating action more closely matches the natural rhythm of the cilia in your nose, but it's also messier, takes longer and is a little more complicated (and it's expensive). Most of the ENTs that I know are recommending the SinusRinse bottles.



I completely understand but it's better than more surgery. I'd recommend that you keep taking the Singulair, start back on the Flonase, and try taking a Claritin every day for two weeks to see if you feel better and are less congested. If things improve then you can try stopping one med at a time to see if you can decrease the number of things you're taking, but it sounds like you're pretty miserable right now and I suspect that you'll feel a lot better once you get this under control.
as far as the antihistamines go, i was taking zyrtec -d 12 hr 2x a day. but after a while, it seemed to be losing it's effect. then i was taking them both at the same time for a while. i really think my body was just getting used to it. i guess it could happen with the zyrtec right? ive used claritin and allergra too, and ive seen no difference. my allergiest told me that They would be too drying out for sinuses...maybe he has seen this often.

now my doctor wants to put me on antibiotics for a month.....then see an ent. honeslty, i doubt that if these antibiotics havent helped in a weeks time, than a month probably wil be worthless. thats why im thinking this could be fungal....

 
Old 10-25-2008, 03:50 AM   #14
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Re: how would you know if you had fungal sinsuitis?

Quote:
i really think my body was just getting used to it. i guess it could happen with the zyrtec right?
It does happen - sometimes antihistamines can become less effective over time (which is why some doctors will recommend that you rotate medications after a while).

Quote:
my allergist told me that They would be too drying out for sinuses...maybe he has seen this often.
They can be drying but you have to decide which is a bigger problem - the inflammation and congestion from your allergies or the potential dryness.

Quote:
now my doctor wants to put me on antibiotics for a month.....then see an ent.
Could you just skip the antibiotics (or take them while you're waiting for an appointment) and see an ENT? A month of antibiotics may help knock down the infection but if your sinuses are inflamed they probably won't address that problem (unless the inflammation is purely the result of an infection). A good ENT may be able to quickly rule out anything fungal and help get to the bottom of what's going on.

I don't know where you live, but I would strongly recommend that you look for an ENT at a teaching hospital or university medical center who specializes in treating chronic sinusitis, and who's willing to work with you over time to get this under control. More surgery probably won't help unless you can get the underlying cause of the inflammation under control.

Last edited by gcsjr; 10-25-2008 at 03:51 AM.

 
Old 10-25-2008, 10:14 AM   #15
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Re: how would you know if you had fungal sinsuitis?

Quote:
Originally Posted by gcsmithjr View Post
It does happen - sometimes antihistamines can become less effective over time (which is why some doctors will recommend that you rotate medications after a while).



They can be drying but you have to decide which is a bigger problem - the inflammation and congestion from your allergies or the potential dryness.



Could you just skip the antibiotics (or take them while you're waiting for an appointment) and see an ENT? A month of antibiotics may help knock down the infection but if your sinuses are inflamed they probably won't address that problem (unless the inflammation is purely the result of an infection). A good ENT may be able to quickly rule out anything fungal and help get to the bottom of what's going on.

I don't know where you live, but I would strongly recommend that you look for an ENT at a teaching hospital or university medical center who specializes in treating chronic sinusitis, and who's willing to work with you over time to get this under control. More surgery probably won't help unless you can get the underlying cause of the inflammation under control.
as far as dryness goes, i Was under the impression that antihistimines make the mucus thicker , preventing drainage. is this true....

i live in orlando, and i moved here about 2 yrs ago. i lived in maryland all my life And had one of the best ents in my area, but as u can see even one of the best couldnt fix my problems. i could go through this surgery again, but i still wouldnt have any of this inflammation Resolved, unless stay dedicated to using my flonase and antihistamines.

im just So scared, and this is giving me anxiety bc nothing is draining. i use my sinus rinse at least 10 times a day. but i know there is an infection bc the xray showed pus and my sinus cavities feel very warm to touch. plus all of the pain killers In world arent helping either. i even take fish oil.

im so depressed. the only time i feel awake is like 4am, so im sleeping in until 12pm every day. i work at a restaurant, and i feel like im constantly in fog and i look like im on drugs....its so embarrassing. i look and feel like Im never awake.

i wish i could just go to the ER and hve them shove something up my nose. i woulo anything for some relief.

Last edited by bebe1983; 10-25-2008 at 11:11 AM. Reason: clarify

 
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