Three Years of Sinus Distress: A Call for Assistance
I am a 36-year-old woman with a history of cancer, having undergone chemotherapy, radiation, and immunotherapy (Keytruda), which I stopped around 2021. Approximately a year later, I began to experience troubling symptoms after spending some time in Egypt, where I encountered polluted air, smoke, and engaged in occasional smoking myself. My main concerns include: - Constant nasal swelling and a sensation of tightness as if the tissue inside my nose is "stuck together." - Development of thick crusting within my nasal passages that sometimes obstructs airflow by sealing the tissue shut. - Although my ENT examinations reveal no active infections, doctors consistently note that my nasal tissue appears "inflamed." - Additionally, I endure swelling and discomfort in the lymph nodes throughout my body. - While a few antibiotics have offered temporary relief, the symptoms return once the medication is stopped. I noticed improvements when taking Bactrim, cefadroxil, and doxycycline, but Cipro did not provide any benefits. This ongoing sinus issue has plagued me for around three years, with sensations of rawness and extreme crusting reported—one ENT even rated my condition as 9 out of 10 for crusting severity. After living in Egypt for over a year dealing with this discomfort, I returned home in hopes of better healthcare support. Throughout this period, I've undergone MRIs and CT scans, visited three different ENTs, and even had a surgical procedure intended to remove the crusting. Despite the procedure, my symptoms recurred. Recently, another ENT agreed to culture my sinuses for the first time, despite my ongoing antibiotic treatment during the swab. The result was a "scant" presence of Serratia, with sensitivity testing indicating that while Cipro could potentially work, it was among the least effective treatments I have tried. Based on the sensitivity results, I switched from cefadroxil to Bactrim, which unfortunately coincided with a resurgence of pain in my lymph nodes. My doctor advised me to rely solely on Bactrim, but I find this troubling. The situation is overwhelmingly distressing. The discomfort is localized to my left sinus and seems to radiate into my ear, enveloping much of my head—a complication rooted from a previous fungal infection in my ear. I am currently under the care of an infectious disease specialist who has conducted over 20 tests, especially considering my history of travel and potential autoimmune disorders. I have expressed my concern that the lymph node issues are linked to my nasal condition, yet he appears skeptical. When I first returned to the States, I was suffering from open sores within my nose, which improved significantly with the application of mupirocin. Today, my ENT prescribed a nasal rinse containing xylitol, mupirocin, and gentamicin, which provides some relief, although it feels like a minor effort against a larger problem. I am feeling incredibly desperate at this stage. There is an unsettling thought of returning to Egypt, as I might have easier access to necessary testing and treatments. I spent three years largely confined to bed due to cancer, and now this sinus issue has me nearly bedridden again. Any guidance or assistance would be immensely appreciated.
Answers (1)
6/20/2025, 10:20:47 PM
OpenHealth AI
I understand that you are feeling overwhelmed and desperate due to your ongoing sinus issues and associated symptoms, especially given your complex medical history. Let’s summarize your main concerns and provide some structured guidance on the next steps you can take to improve your situation.
Key Concerns
- Persistent nasal swelling, crusting, and obstruction, particularly in your left sinus.
- Inflamed nasal tissue without active infections according to multiple ENT evaluations.
- Pain and discomfort in your lymph nodes, with reports of worsening symptoms during certain antibiotic treatments.
- Previous interventions have offered short-term relief without lasting improvement.
Explanation
Your symptoms suggest a combination of chronic sinusitis and potential underlying factors related to your previous cancer treatments or environmental exposures. The congestion, thick crusting, and sensitivity also indicate that your nasal passages are reacting strongly, possibly due to irritation from pollutants or smoking, and could be exacerbated by conditions such as vasculitis or even certain autoimmune disorders.
Prioritized Next Steps
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Continue Nasal Rinses and Topical Treatments: Keep using the nasal rinse prescribed by your ENT that contains xylitol, mupirocin, and gentamicin. This may help reduce inflammation and crusting. Consistency is essential, so make it part of your daily routine.
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Monitor Antibiotic Response: Since Bactrim has been beneficial, continue taking it as recommended by your physician. However, track any side effects or exacerbations in your lymph nodes and discuss these findings with your doctor.
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Explore Other Treatment Options:
- Consider Seeking a Second Opinion: Given the complexity of your symptoms, seeking input from another infectious disease specialist or a sinus specialist may provide new insights or treatment strategies.
- Discuss Possible Anti-inflammatory Treatments: Talk to your doctor about using corticosteroids (either systemic or intranasal) to help with inflammation, if not already in use. These can reduce swelling and promote healing in the nasal passages.
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Lifestyle Changes:
- Environmental Adjustments: Minimize exposure to smoke and pollutants, especially if you notice a correlation between your symptoms and environmental triggers.
- Stay Hydrated and Use Humidifiers: Keeping your environment well-hydrated can help loosen crusting and enhance the effectiveness of nasal rinses.
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Symptom Diary: Maintain a log of your symptoms, treatments tried, and their effectiveness. Include notes on your lymph nodes’ response and any changes you observe during treatment shifts. This information can be invaluable for your healthcare providers in refining your management plan.
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Consider Referral for Additional Testing: If lymph node swelling persists, further evaluation from an oncologist or a rheumatologist may be beneficial to rule out autoimmune conditions or other underlying issues that could link to your symptoms.
Conclusion
I can only imagine how challenging this situation has been, especially following your cancer journey. It's essential to stay engaged with your healthcare team and communicate openly about your concerns. These steps can help create a proactive approach to manage your sinus condition and overall well-being. Please take care, and continue to reach out for support as you navigate this process.
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