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Medical Forum / Diseases and Disorders / Sinusitis / October 2005nebulized itraconazole
my most recent visit to an ENT has reconfirmed my diagnosis of being someone who suffers from "Chronic Sinusitis". my sinuses are described as "unhealthy" and "diseased". However, i remain steadfast in my belief that i will one day discover the one (or more) thing that i need to introduce or remove from my lifestyle to make myself better. my main complaint is constant, persistent post nasal drip and/or thick mucous buildup. a feeling at the back of the roof of my mouth that there is always something there. i always feel this, and need to snort all the time. at its very worse, like the 2 days preceeding a cold, which i get often, i cannot sleep and every 30 seconds i need to snort and hack out the stuff. Has anyone else notice the 2 days at the start of a cold(before being congested) to be among the worse? i irrigate regularly with the hydropulse and neti pot and drink much tea. one recent change in my treatment. i noticed that i had some white buildup at the back of my tongue. this comes and goes and a previous ENT had shrugged it off as mucous although i told him that i couldnt scrape it off without pain and bleeding. a culture showed that it was a yeast infection. although i took NYstatin, this stuff comes and goes and i think is directly related to the PND - it does show up way at the back of the tongue. the ENT did take a culture but he told me that this would likely NOT show fungus becuase that was difficult to culture for. he told me that what might help me is nebulized itraconazole. 30 milligrams 2 X day for 3 weeks. i am waiting to hear if my insurance company is going to cover this. has anyone else ever had this issue and/or used this medication? my PND became evident at the same time that i quit smoking cigarettes. is there anything that the tobacco use had in it to "help" my situation? thanks Just curious how long did you smoke, how heavy and when did you quit? Although I never smoked, I have a relative who quit who subsequently got sinus infections after quitting. It took a while for her body to recover from the smoking and resolve the sinus infections. I am sure this is dependant on your smoking history. As far as the yeast in the back of the throat, I had a similar thing one time and took 100 mg of Diflucan for 10 days and it resolved the problem. If it is in the sinuses, I don't believe that the Diflucan works there though. Also I wanted to tell you not to give up and keep a positive attitude as you have in your first paragraph. If a doctor makes you feel hopeless, time to get a new doctor. All of us on this forum have been through a lot but in most cases you can do a lot to improve your sinus health and get to a steady state. Thanks, i will persist. I know i have "chronic" sinus issues but am not really sure if the PND is a symptom of it. i did do allergy shots for a year but may revisit this. i smoked for at least 15 years. i quit about 8 years ago. my primay doctor had given me a prescription for 10 days of Diflucon but the pharmacist rejected it because of my health insurance. rather than protest the doctor instead told me to wait for the ents recomendation. If you decide to go for allergy shots again they will retest you. You can change what you are allergic too. I did 8 years of allergy shots and they worked well for me. Recently I got retested and now am allergic to mold which is a bummer because it is in the outside air from late spring into fall. I am planning to start the mold allergy shots soon. In the past, the shots worked for me but I think it took 2 years to get the full affect. My allergist said that 1/3 drop out too quickly, 1/3 are helped somewhat and 1/3 are greatly helped. So may be you didn't give them enough time. Get a place that is convenient to you this helps to keep going. One suggestion -I added dust mite shots even though I tested negative and this helped me greatly. I also did all the dust preventative stuff to my bedroom. If you do the shots again, if you don't test positive for dust mites you could add this shot anyways and see if makes a difference for you. One more thing you could have your self checked for GERD. GERD can be silent "no heartburn". Some symptons I had were presistent sore throat and hoarseness in the morning. Another common symptom is clearing your throat often or bringing up acidy tasting mucous which can resemble PND. Good luck! > One more thing you could have your self checked for GERD. GERD can be > silent "no heartburn". Some symptons I had were presistent sore throat and > hoarseness in the morning. Another common symptom is clearing your throat > often or bringing up acidy tasting mucous which can resemble PND. That doesn't sound right in this case. His symptoms get worse during a cold, and he was a smoker. That points to a respiratory issue rather than a digestive issue. I've thought that this reflux theory often violates Occam's Razor--often introducing a red herring unnecessarily. When you've got a history of respiratory issues (and smoking for 15 years, by definition, is a respiratory issue), then that's the first place to start looking. Otherwise you would have to explain how reflux magically gets worse at the onset of a cold.  SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. I agree given the smoking history you are right. This is just my new favorite diagnosis to tell people about... I was completely shocked when I was told I had GERD and never had heartburn or stomach issues. > Thanks, i will persist. I know i have "chronic" sinus issues but am not > really sure if the PND is a symptom of it. i did do allergy shots for a [quoted text clipped - 4 lines] > my primay doctor had given me a prescription for 10 days of Diflucon but > the pharmacist rejected it because of my health insurance. A good compromise might be Mycelex Troches. They can be effective against oral yeast (thrush), and I'll bet they're less expensive than Diflucan, if you have to pay out of pocket. Please don't let your medical treatment be dictated by your insurance company, to the extent that you choose incorrect medications just because your insurance company refuses to pay for the right medications. You can always appeal your case with your insurance company. And if all else fails, you can pay out of pocket and deduct the cost from your income tax. Here in Massachusetts, a few years ago, at least one of the HMOs announced they would no longer pay for the minimally sedating antihistamines, suggesting that nasal steroid sprays were an adequate substitute (conveniently forgetting about all those patients with asthma, hives and eczema). There was such a huge outcry--even the asthma specialists in Massachusetts lobbied them to change their minds--that they soon reversed themselves. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. >Thanks, i will persist. I know i have "chronic" sinus issues but am not >really sure if the PND is a symptom of it. i did do allergy shots for a [quoted text clipped - 5 lines] >the pharmacist rejected it because of my health insurance. rather than >protest the doctor instead told me to wait for the ents recomendation. A lot of insurance companies put the kibosh on Diflucan scripts, other than single use. Pricey stuff. Diflucan is a systemic and powerful and if the candida is someplace other than your mouth, it is one of the good ways to go after it. If it is limited to the mouth, though, clotrimazole troches (also a prescription product), dissolved in the mouth can often help. They need to be used 5x/day for 2 weeks, though. Some insurers take more kindly to it that the Diflucan. If you have been on several courses of antibiotics for the sinuses or inhale steroids for asthma, or are immunocompromised through illness or other medications, yeast infections can pop up and sometimes it can take awhile to get them under control. Boron > my main complaint is constant, persistent post nasal drip and/or thick > mucous buildup. a feeling at the back of the roof of my mouth that there [quoted text clipped - 3 lines] > the stuff. Has anyone else notice the 2 days at the start of a > cold(before being congested) to be among the worse? Before I had sinus surgery, colds produced so much PND that I was literally gagging and choking--so much crap was pouring down my airway that I nearly choked on my own phlegm. With me, it wasn't "Post Nasal Drip," it was "Post Nasal Flood." > one recent change in my treatment. i noticed that i had some white > buildup at the back of my tongue. this comes and goes and a previous ENT [quoted text clipped - 9 lines] > > has anyone else ever had this issue and/or used this medication? I got lots of oral thrush (yeast infection) from repeated courses of antibiotics, combined with those damn steroid inhalers I used to take for my asthma. Some antibiotics kill off the good bacteria in your mouth, enabling the yeast to get a foothold. I never heard of using nebulized antifungals to control oral thrush. My physician told me that the longer the medication stays in contact with the yeast, the more effective it will be. My physicians, both ENT and asthma specialist and my dentist too, all prefer Mycelex Troches (lozenges), 2 weeks' worth; each can last in the mouth up to a half hour. When that fails, they will prescribe oral Diflucan tablets (150 mg/day for 3 weeks). As you treat the thrush with whatever medications you use, buy a tongue scraper and start scraping off that gunk. (It will come off more easily as the medications take effect.) And after the thrush is over, use a tongue scraper regularly, every time you brush your teeth. My dentist has found that helps his patients control their oral thrush (that's something my ENT never mentioned to me). SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. Thanks, i think that the nebulized antifungal has been prescribed under the assumption that the yeast infection has spread to my sinuses. can this happen? can this treatment be valuable? > Thanks, > > i think that the nebulized antifungal has been prescribed under the > assumption that the yeast infection has spread to my sinuses. can this > happen? can this treatment be valuable? If the yeast infection is severe, it can creep up the back of your throat till it enters your nasopharynx, yes. But if it's that severe, you'll need strong medication to get it out of your throat and tongue too. That is unlikely to clear by itself. That's why Diflucan is probably the best choice when the infection is spreading like that. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. On 10/27/05 7:10 AM, in article cb95b9344c469e956d8db605eae8a680@localhost.talkaboutsupport.com, "loxaluck" > my PND became evident at the same time that i quit smoking cigarettes. is > there anything that the tobacco use had in it to "help" my situation? What happens is that the tobacco acts as an irritant, much like smoke in your eye. Then when you stop smoking, no more irritatant, there is a rebound with swelling and blockage, etc. In most persons eventually this cools off. If you are till having thick mucus, ask your doctor aobut using Clear.ease for this. Any kind of abnormal flora in the mouth can be helped by yogurt and similar "normal good" bacteria. > On 10/27/05 7:10 AM, in article > cb95b9344c469e956d8db605eae8a680@localhost.talkaboutsupport.com, "loxaluck" [quoted text clipped - 5 lines] > your eye. Then when you stop smoking, no more irritatant, there is a rebound > with swelling and blockage, etc. The same thing can happen in the lower respiratory tract. Some chain smokers are disappointed to find that if they quit smoking, they actually start coughing more (though more productively). But that's actually a good sign; the cilia in the lungs are now clearing out all that gunk faster than it can accumulate. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. I had heard that but never experienced it. but it is now 8 years since i quit smoking. i dont believe it would have taken this long for the production expulsion of stuff. right? thanks,
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