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Medical Forum / Diseases and Disorders / Sinusitis / July 2006My Sinusitis Saga, what now?
Alright, my circumstances are probably not as serious as many of you, but they have proved to be life-crippling none-the-less. About 6 months ago I started having certain vague symptoms that I couldn't put a finger on. The first thing I noticed was a general disorientation and inability to focus. After about a month of being "mentally disarmed," I went into my doc with my only system to report pretty subtle and, I'm sure, difficult to diagnose. I had the usual round of blood tests done, all showing me to be in the prime of life. My doc basically told be to put my concerns on hold and hope whatever it was passed naturally... That didn't happen. Instead, I finally had a few more symptoms join the first. Fairly mild but ever-present headaches was the first thing of notice. Anything else went unnoticed for a while, but in hind sight I recall that around this time I started to have odd congestion-related problems. My ears would plug up pretty frequently, and twice one ear has gone completely useless for over 24 hours. My nose would get stuffed up as well but that I can normally attribute to my allergies. The only other thing of note would be that I seemed to get sick more often than what was usual for that time of year, and one time it evolved into bronchitus, which I'd never had before. The dizzyness/foginess at one time I figured may hint that I needed glasses, so I went to the Opthamologist to only again be given a clean bill of health. Finally I went back to my Doc, he got me into an MRI, and I finally got some results. The $1500 MRI told me what a $300 CT scan could have, that I had "moderate sinusitis." ...so, first he gave me a 2-week round of Augmentin - did nothing. Next I was put on another 2 week course of another anti-biotic called Cipro, which I quit prematurely because I thought I might be having an allergic reaction. As it stands now I've just started a more aggressive Augmentin treatment (4 pills/day for about a month), and my Doc wants me to schedule an appointment with a Neurologist. Yep, a Neurologist...he still believes that I may have other problems causing the dis-orientation because it's a symptom he says doesn't normally go hand-in-hand with sinusitis. Browsing some of your posts leads me to disagree. So would the best course of action be for me to insist on seeing one of these ENT's, or does this sound like it may be something other than sinusitis? I've probably written too much, and no-one will read this far, but on the off chance that you did I could use some advice....? Thx! Why not see both and ENT and a Neurologist? Actually CT scans lead to mroe precise diagnoses than MRI's for most forms of sinusitis (but not fungal or cancer, so the MRI was useful to have to rule those out). >Alright, my circumstances are probably not as serious as many of you, >but they have proved to be life-crippling none-the-less. [quoted text clipped - 43 lines] >far, but on the off chance that you did I could use some advice....? >Thx! > ...so, first he gave me a 2-week round of Augmentin - did nothing. Next > I was put on another 2 week course of another anti-biotic called Cipro, > which I quit prematurely because I thought I might be having an > allergic reaction. What were the symptoms of your "allergic reaction"? > So would the best course of action be for me to insist on seeing one of > these ENT's, or does this sound like it may be something other than > sinusitis? Sinusitis is difficult to diagnose. Its symptoms are subjective and can resemble those of other diseases. I had to see *three* different ENTs before I found one that diagnosed me properly. So yes, given your history of allergies and ear stuffiness and a positive MRI, I would suggest you see a couple more ENTs. If several courses of antibiotics have failed, you may need to consider surgery. That's the boat I was in.  SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. I've always suffered various forms of allergies. The most notable would be hay fever and assorted food allergies, and according to my Doc these "set the table" for my sinusitis. About a week into the Cipro I started having restricted breathing, lethargy, and a general feeling of lousiness. Also, you know when your heart skips a beat? I seemed to be experiencing increased activity in that area.... I'm not sure now whether those symptoms were due to the Cipro as they haven't subsided fully (it's been a week and a half since I stopped), but I do feel a bit better. I'm kind of demoralized drug wise anyhow...right now I'm taking some more Augmentin, which I tend to look at as just another way to delay a real treatment, as they haven't done diddly for me. Thanks for you replies guys! > > ...so, first he gave me a 2-week round of Augmentin - did nothing. Next > > I was put on another 2 week course of another anti-biotic called Cipro, [quoted text clipped - 20 lines] > Email: sdlitvin@earthlinkNOSPAM.net > Remove the NOSPAM before replying to me. > I've always suffered various forms of allergies. The most notable would > be hay fever and assorted food allergies, and according to my Doc these [quoted text clipped - 6 lines] > Cipro as they haven't subsided fully (it's been a week and a half since > I stopped), but I do feel a bit better. Unfortunately, quinolones can change cardiac rhythms in sensitive people. It's a good thing you stopped taking the Cipro. You don't want to add cardiac arrhythmia to your list of problems. > I'm kind of demoralized drug wise anyhow...right now I'm taking some > more Augmentin, which I tend to look at as just another way to delay a > real treatment, as they haven't done diddly for me. Your next step might be a macrolide antibiotic like Biaxin or Ketek. Or maybe a cephalosporin like Ceftin. If all those fail, then it's time to think about surgery. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. Frequently there are postings here re irrigation with Hydrogen Peroxide. I thought this article should be of interest: Hydrogen Peroxide Poisoning Authors: Barbara E. Watt1; Alex T. Proudfoot1; J. Allister Vale1 Source: Toxicological Reviews, Volume 23, Number 1, 2004, pp. 51-57(7) Publisher: Adis International Abstract: Hydrogen peroxide is an oxidising agent that is used in a number of household products, including general-purpose disinfectants, chlorine-free bleaches, fabric stain removers, contact lens disinfectants and hair dyes, and it is a component of some tooth whitening products. In industry, the principal use of hydrogen peroxide is as a bleaching agent in the manufacture of paper and pulp. Hydrogen peroxide has been employed medicinally for wound irrigation and for the sterilisation of ophthalmic and endoscopic instruments. Hydrogen peroxide causes toxicity via three main mechanisms: corrosive damage, oxygen gas formation and lipid peroxidation. Concentrated hydrogen peroxide is caustic and exposure may result in local tissue damage. Ingestion of concentrated (>35%) hydrogen peroxide can also result in the generation of substantial volumes of oxygen. Where the amount of oxygen evolved exceeds its maximum solubility in blood, venous or arterial gas embolism may occur. The mechanism of CNS damage is thought to be arterial gas embolisation with subsequent brain infarction. Rapid generation of oxygen in closed body cavities can also cause mechanical distension and there is potential for the rupture of the hollow viscus secondary to oxygen liberation. In addition, intravascular foaming following absorption can seriously impede right ventricular output and produce complete loss of cardiac output. Hydrogen peroxide can also exert a direct cytotoxic effect via lipid peroxidation. Ingestion of hydrogen peroxide may cause irritation of the gastrointestinal tract with nausea, vomiting, haematemesis and foaming at the mouth; the foam may obstruct the respiratory tract or result in pulmonary aspiration. Painful gastric distension and belching may be caused by the liberation of large volumes of oxygen in the stomach. Blistering of the mucosae and oropharyngeal burns are common following ingestion of concentrated solutions, and laryngospasm and haemorrhagic gastritis have been reported. Sinus tachycardia, lethargy, confusion, coma, convulsions, stridor, sub-epiglottic narrowing, apnoea, cyanosis and cardiorespiratory arrest may ensue within minutes of ingestion. Oxygen gas embolism may produce multiple cerebral infarctions. Although most inhalational exposures cause little more than coughing and transient dyspnoea, inhalation of highly concentrated solutions of hydrogen peroxide can cause severe irritation and inflammation of mucous membranes, with coughing and dyspnoea. Shock, coma and convulsions may ensue and pulmonary oedema may occur up to 2472 hours post exposure. Severe toxicity has resulted from the use of hydrogen peroxide solutions to irrigate wounds within closed body cavities or under pressure as oxygen gas embolism has resulted. Inflammation, blistering and severe skin damage may follow dermal contact. Ocular exposure to 3% solutions may cause immediate stinging, irritation, lacrimation and blurred vision, but severe injury is unlikely. Exposure to more concentrated hydrogen peroxide solutions (>10%) may result in ulceration or perforation of the cornea. Gut decontamination is not indicated following ingestion, due to the rapid decomposition of hydrogen peroxide by catalase to oxygen and water. If gastric distension is painful, a gastric tube should be passed to release gas. Early aggressive airway management is critical in patients who have ingested concentrated hydrogen peroxide, as respiratory failure and arrest appear to be the proximate cause of death. Endoscopy should be considered if there is persistent vomiting, haematemesis, significant oral burns, severe abdominal pain, dysphagia or stridor. Corticosteroids in high dosage have been recommended if laryngeal and pulmonary oedema supervene, but their value is unproven. Endotracheal intubation, or rarely, tracheostomy may be required for life-threatening laryngeal oedema. Contaminated skin should be washed with copious amounts of water. Skin lesions should be treated as thermal burns; surgery may be required for deep burns. In the case of eye exposure, the affected eye(s) should be irrigated immediately and thoroughly with water or 0.9% saline for at least 1015 minutes. Instillation of a local anaesthetic may reduce discomfort and assist more thorough decontamination. Keywords: Hydrogen peroxide, adverse reactions; Poisoning Document Type: Review article Affiliations: 1: National Poisons Information Service (Birmingham Centre), When I mentioned Hydrogen Peroxide Irrigation to my ENT....he nearly fell off his chair saying NO....NOT UNDER ANY CIRCUMSTANCES as even mild doses can damage the mucus/sinus coatings Kindest personal regards, Ray The Travellin' Man.....Ray Armstrong your eyes and ears on the Tweed!! Let's Keep Music Liiiiiiiiiiiive!!!!!!! > Frequently there are postings here re irrigation with Hydrogen Peroxide. I > thought this article should be of interest: [quoted text clipped - 83 lines] > > Affiliations: 1: National Poisons Information Service (Birmingham Centre), Does this mean cleaning the Hydropulse irrigator with hydrogen peroxide 3% is not recommended? I did that once and rinsed the machine out with water but since my sense of smell is not great, could not detect the lingering odors left in the machine. Would that have harmed my cilia? > When I mentioned Hydrogen Peroxide Irrigation to my ENT....he nearly fell > off his chair saying NO....NOT UNDER ANY CIRCUMSTANCES as even mild doses [quoted text clipped - 103 lines] > > > > Affiliations: 1: National Poisons Information Service (Birmingham Centre), > Does this mean cleaning the Hydropulse irrigator with hydrogen peroxide > 3% is not recommended? I did that once and rinsed the machine out with > water but since my sense of smell is not great, could not detect the > lingering odors left in the machine. Would that have harmed my cilia? The abstract Murray posted referred only to "highly concentrated" hydrogen peroxide, 35% or greater, I believe. Susan On 7/26/06 3:02 AM, in article 1153908177.960931.281160@b28g2000cwb.googlegroups.com, "chrisw" <sanufi@gmail.com> wrote: > Does this mean cleaning the Hydropulse irrigator with hydrogen peroxide > 3% is not recommended? I did that once and rinsed the machine out with > water but since my sense of smell is not great, could not detect the > lingering odors left in the machine. Would that have harmed my cilia? Using Hydrogen peroxide 3% is correct for cleaning / sterilizing the Hydro Pulse, just be sure to rinse it out afterwards. Murray Grossan, M.D. Www.ent-consult.com Www.grossan.com Interesting Ray in my experience two summers ago at the Lahey Clinic in Burlington, MA my ENT irrigated my left maxillary sinus with a mixture of betadine and H2O2. Actually he instilled the mixture and I would let it drain out after several minutes. This was done on a weekly basis for maybe six weeks or more. So there are differences of opinion in the medical field. But more importantly it didn't solve or cure the problem. John > When I mentioned Hydrogen Peroxide Irrigation to my ENT....he nearly fell > off his chair saying NO....NOT UNDER ANY CIRCUMSTANCES as even mild doses [quoted text clipped - 3 lines] > Ray The Travellin' Man.....Ray Armstrong your eyes and ears on the Tweed!! > Let's Keep Music Liiiiiiiiiiiive!!!!!!! > Interesting Ray in my experience two summers ago at the Lahey > Clinic in Burlington, MA my ENT irrigated my left maxillary sinus with a > mixture of betadine and H2O2. I'm sure the concentration of H2O2 your ENT used on you was far below the 35% concentration referred to in the article. It's probably closer to the 3% concentration you buy in the drugstore, which if anything is too weak to be effective. Heck, when I have a root canal for an abscessed tooth, my dentist injects my tooth abscess with a dilute solution of sodium hypochlorite. That's right, he shoots Clorox into my tooth! But at that low concentration, it's not corrosive to the tissues, just disinfects them. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. Yes Steven the H2O2 he used was the same found in your local CVS/Walgreens, etc. As for effectiveness, I think that would vary from person to person depending on the underlying cause of their sinusitis. But more importantly he was able to instill the mixture directly into the maxillary sinus endoscopically hoping to clear up an infection he described as looking like a cesspool. And as I said it neither cured or solved my problem. > I'm sure the concentration of H2O2 your ENT used on you was far below > the 35% concentration referred to in the article. It's probably closer [quoted text clipped - 5 lines] > That's right, he shoots Clorox into my tooth! But at that low > concentration, it's not corrosive to the tissues, just disinfects them. There was just an alert from the FDA regarding 35% hydrogen peroxide: basically to avoid it. I've always been told by wound surgeons that hydrogen peroxide is toxic to tissues. Betadine as well. Here's the FDA alert: MedWatch - The FDA Safety Information and Adverse Event Reporting Program FDA warned consumers not to purchase or to use high-strength hydrogen peroxide products, including a product marketed as "35 Percent Food Grade Hydrogen Peroxide," for medicinal purposes because they can cause serious harm or death when ingested. FDA recommends that consumers who are currently using high-strength hydrogen peroxide stop immediately and consult their health care provider. FDA has never approved high-strength hydrogen peroxide to be taken internally and considers hydrogen peroxide at 35 percent strength dangerous, even if handled according to the manufacturer's directions. High-strength hydrogen peroxide -- more than 10 times stronger than the solution used in over-the-counter drugs to disinfect minor cuts -- is highly corrosive. Ingesting hydrogen peroxide can cause gastrointestinal irritation or ulceration. Intravenous (IV) administration of hydrogen peroxide can cause inflammation of the blood vessel at the injection site, gas embolisms (bubbles in blood vessels), and potentially life-threatening allergic reactions. Read the complete MedWatch 2006 Safety summary, including a link to the FDA news release, at: http://www.fda.gov/medwatch/safety/2006/safety06.htm#Peroxide Judy > > Interesting Ray in my experience two summers ago at the Lahey > > Clinic in Burlington, MA my ENT irrigated my left maxillary sinus with a [quoted text clipped - 14 lines] > Email: sdlitvin@earthlinkNOSPAM.net > Remove the NOSPAM before replying to me. > There was just an alert from the FDA regarding 35% hydrogen peroxide: > basically to avoid it. I've always been told by wound surgeons that > hydrogen peroxide is toxic to tissues. Betadine as well. > Here's the FDA alert: > MedWatch - The FDA Safety Information and Adverse Event Reporting > Program Yabbut, we've only discussed use of diluteed 3% here. Susan Understood, but I was sort of responding to Murray Grossan's post. I've still been told that 3% hydrogen peroxide is toxic to wounds and by extrapolation to mucosa. I do use it for disinfecting toothbrushes and saxophone reeds. Judy > x-no-archive: yes > [quoted text clipped - 8 lines] > > Susan > Understood, but I was sort of responding to Murray Grossan's post. I've > still been told that 3% hydrogen peroxide is toxic to wounds and by > extrapolation to mucosa. Even if diluted in water? When I use it, I add a capful or two to 2 cups of saline solution. Susan My sister once sent me a web article of a man who "flooded" his sinuses : essentially filling them with peroxide rinse and then positioning himself on his knees with the top of his head on the shower floor. I sent it along to my ENT who agreed with the position, but was concerned about the hydrogen peroxide. Bottom line, I don't have any evidence to support the contention that it's harmful. Judy > x-no-archive: yes > [quoted text clipped - 6 lines] > > Susan > My sister once sent me a web article of a man who "flooded" his sinuses > : essentially filling them with peroxide rinse and then positioning > himself on his knees with the top of his head on the shower floor. Yes, CanDo! He posted it here regularly, then stopped. I > sent it along to my ENT who agreed with the position, but was concerned > about the hydrogen peroxide. > Bottom line, I don't have any evidence to support the contention that > it's harmful. CanDo used a strong solution, he described PAIN. Still, he didn't have to keep doing it, he claimed it really worked for him. Susan Actually my sister did it as an act of desperation when multiple courses of antibiotics were of no help: I believe she just used her usual neti saline solution. She said it was gross, but effective. I think she complained her ears got stuffed up for a few days also. Judy > x-no-archive: yes > [quoted text clipped - 14 lines] > > Susan > Actually my sister did it as an act of desperation when multiple > courses of antibiotics were of no help: I believe she just used her > usual neti saline solution. She said it was gross, but effective. I > think she complained her ears got stuffed up for a few days also. She did upside down, or strong hydrogen peroxide upside down? Susan I believe she used her regular saline solution, flooded her sinuses, held the "prayer" position--with the top of her head on the bottom of the tub for as long as she could stand it. She said she had copious mucous drainage afterward;it was a mess, but it cleared up a stubborn infection. I think her ears were blocked a bit though. She definitely got the initial idea from the CanDo posts. Judy > x-no-archive: yes > [quoted text clipped - 6 lines] > > Susan > I believe she used her regular saline solution, flooded her sinuses, > held the "prayer" position--with the top of her head on the bottom of > the tub for as long as she could stand it. She said she had copious > mucous drainage afterward;it was a mess, but it cleared up a stubborn > infection. I think her ears were blocked a bit though. > She definitely got the initial idea from the CanDo posts. Really, it worked without the peroxide! Hmmph! Susan Thanks for that...YES...I asked him about Bedtadine too because my wife is an RN and they use it all of the time in hospitals and again my ENT was dead against that too-he was only for saline solution as he formed the opinion that other fluids like those mentioned would damage the mucosal lining. -- Kindest personal regards, Ray The Travellin' Man.....Ray Armstrong your eyes and ears on the Tweed!! Let's Keep Music Liiiiiiiiiiiive!!!!!!! > Interesting Ray in my experience two summers ago at the Lahey > Clinic in Burlington, MA my ENT irrigated my left maxillary sinus with a [quoted text clipped - 13 lines] > > Ray The Travellin' Man.....Ray Armstrong your eyes and ears on the Tweed!! > > Let's Keep Music Liiiiiiiiiiiive!!!!!!! I have gotten beyond the point of worrying about damaging the mucosal lining especially when an infection wipes me out for a week or more along with the antibiotic rollercoaster. The good news is I haven't had to use antibiotics to treat my sinus infections for almost 2 years now. I have been able to do this by aggresively irrigating my sinuses when an infection is brewing and twice daily irrigations otherwise. > Thanks for that...YES...I asked him about Bedtadine too because my wife is > an RN and they use it all of the time in hospitals and again my ENT was dead > against that too-he was only for saline solution as he formed the opinion > that other fluids like those mentioned would damage the mucosal lining. hydromed@adelphia.net (Murray Grossan) wrote: >Frequently there are postings here re irrigation > with Hydrogen Peroxide. I thought this article > should be of interest: Ridiculous!! ...Why would you even bother to post such an article that has nothing to do with sinus irrigation. ...We're not talking about irrigating the sinuses with a 35% solution of peroxide. (which would be impossible to do, anyways) ...Rather, what we are dealing with is a 3% H²O² solution that is further cut by another 95%. ...Jesus... Glug a jug of bleach down, and you're dead, but put a few drops in a gallon of water and you kill all the harmful bacteria. ....How about posting some articles that actually pertain to its use in sinus irrigation. ..I've tried the peroxide solution a number of times, and the bottom line is: it works. ...Jon If the cipro has caused some type of mild cardiac arrhythmia, would it stick around after I dropped the drug? I ask only because the symptoms that cropped up around that time (lightheadedness, shortness of breath, awareness of heartbeat, etc) haven't totally subsided. I've also felt very weak/lethargic during the times when these are most noticeable, which hadn't been a previous symptom of my sinusitis.... God, I've got problems... Thx! > > I've always suffered various forms of allergies. The most notable would > > be hay fever and assorted food allergies, and according to my Doc these [quoted text clipped - 23 lines] > Email: sdlitvin@earthlinkNOSPAM.net > Remove the NOSPAM before replying to me. > If the cipro has caused some type of mild cardiac arrhythmia, would it > stick around after I dropped the drug? I ask only because the symptoms > that cropped up around that time (lightheadedness, shortness of breath, > awareness of heartbeat, etc) haven't totally subsided. I've also felt > very weak/lethargic during the times when these are most noticeable, > which hadn't been a previous symptom of my sinusitis.... heart skipping beats is palpitations, a known but relatively uncommon side effect of Cipro. Now of course you're more aware of these feelings, so it could just be emotional stress. But if you're concerned, ask your doctor. He can give you an EKG and find out for sure. Many people have mild or intermittent cardiac conditions they're not aware of--until the day something really pops. The producers of the TV reality show "Fear Factor" said they give each contestant an EKG before allowing them to do any stunts. On several occasions, the EKG picked up a mild arrhythmia the young contestant was totally unaware of. They disqualified her from the show--but at least she found out about it in time to have it treated by a doctor! SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. >If the cipro has caused some type of mild cardiac arrhythmia, would it >stick around after I dropped the drug? I ask only because the symptoms [quoted text clipped - 4 lines] > >God, I've got problems... The occasional skipped beat is very common and is usually benign. It can easily be aggravated by drugs. But, as Stevn says, might as well get an EKG (under $100) just in case........ Steven is RIGHT about sinusitis being difficult to diagnose-It took 5 months before mine was diagnosed after gastroscopy,colonscopy several Drs including a brain scan for a tumour which "accidently" picked up "extensive sinus disease in the ethmoid,sphenoid,maxillary and frontal sinuses" -- Kindest personal regards, Ray The Travellin' Man.....Ray Armstrong your eyes and ears on the Tweed!! Let's Keep Music Liiiiiiiiiiiive!!!!!!! > > ...so, first he gave me a 2-week round of Augmentin - did nothing. Next > > I was put on another 2 week course of another anti-biotic called Cipro, [quoted text clipped - 20 lines] > Email: sdlitvin@earthlinkNOSPAM.net > Remove the NOSPAM before replying to me.
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