Discussions that mention singulair

Allergies board


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.
[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.
[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.
[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.