My recent experience was similar, I had less PND during my infection.
My layman's explanation is that due to blockage my mucus wasn't
flowing, so no pnd but an infection.  My first round of antibiotics
didn't work.  The ENT prescribed predinose to open up the sinuses along
with a second round antibiotics and voila, no more infection.

Why?  The Mayo Clinic (the ones who pioneered the theory of Allergic
Fungal Sinusitis) now says that there is usually visual evidence of
visible inflammation and eosinophils, when AFS is the culprit.  If you
go there and ask them directly, they no longer claim that AFS is the
cause of nearly all chronic sinusitis, as they used to.  So your ENT had
better have evidence of fungal involvement (or hints from your patient
history), not just making fungus the default diagnosis because
antibiotics failed.

And even if the problem is fungal, the infection won't clear unless the
ostia are opened and drained.  Irrigation with topical antifungals can
be effective, but only if the irrigation solution can get into the sinus
cavities.

Oral steroids (Medrol, etc.) might reduce the swelling enough for
drainage to occur spontaneously, or for fungal irrigation to work.
Other than surgery, that's your best bet for opening your sinuses.

This makes perfect sense.   As others have stated,  if the ostia are
blocked, the pus has nowhere to go, but it could spread to the bone or
even to your brain if you don't get it treated.  The usual treatment
nowdays is limited surgery just to open up the ostia and allow the
mucus to drain better.   Then something I think is lacking in many ENT
encounters is that the actual bacteral and/or fungal infection(s)
should be addressed with the appropriate antimicrobial.  Whereever you
go, I would ask them to do cultures and test for MBP.  I think that the
presence of MBP and postive fungal cultures is required for the
diagnosis of allergic "eosinophilic" fungal sinusits.  But you do need
to be aware that there are many different kinds of fungal sinusitis,
and you don't state whether your doctor thinks it is a fungal infection
or an "allergic" or immune type reaction (And there are even different
criteria used by each doctor for the same diagnosis) .  An actual
infection would be unlikely unless you are immunocompromised, but is
possible.

Kathyw

Kathyw

Terry,
 I live in RI also, and my daughter lives outside Boston. We have a
local ENT, Paul Christu. who I really like and respect. Because my
daughter was near Boston, when she developed unremitting sinusitis, I
took her to Peter Catalano at Lahey Clinic. He was recommended by a
pediatric allergist I know, who had gone to him for sporanox treatment
several years ago, when it was not widely being used.
 We initially saw an older ENT, a Dr. Hybels, who was not very
helpful. After waiting for 5 months, she saw Dr. Catalano who
recommended surgery with the sinus balloon. He was very pleasant, but
she really didn't want the surgery--and when I discussed the use of the
balloon with Dr. Christu, he had some additional reservations about it.
 Dr. Catalano recommended the surgery, and his assistant came into the
room after he left and gave my daughter a hard time: he was booking out
another 5 months, if she didn't sign the consent form right then, her
wait would only be longer. The harder the push, the more resistance
from my daughter (in her early 20's)
 We saw Dr. Christu for a second opinion, and he told her he could
perform minimal FESS, but with her IgA deficiency: "your CT could look
perfect, but you could still get infections". He wouldn't offer her any
guarantees about the health benefits of the surgery.
  In contrast, Dr. Catalano told her she would have no pain, and would
be much better. In fact, he had performed the same surgery on a family
member.
 Weighing both opinions, my daughter decided to stick with medical
management--irrigation, allergy shots, low dose biaxin. Her fiance, a
physician, agrees with her that surgery can't be un-performed, and it's
not clear that the risks--in this case--outweigh the benefits.
 I did not get the feeling in dealing with either ENT, that they would
care for her medically or offer continuity. It seemed like a consult
practice, one that referred you back to your usual MD. In contrast, Dr.
Christu has cared for her for years.
 The pediatric allergist who used Dr. Catalano thinks the world of
him. In his case, he continued to get infections despite FESS, and
heard about the sporanox at a national allergy meeting, and found that
Dr. Catalano was the only ENT willing to try it in the NE area--at the
time (5 years ago.)
 So, that's our experience with Lahey.
 I personally saw a highly recommended private ENT who uses Mass Eye
and Ear and had a horrible experience--actually I mentioned it to Dr.
Catalano, and he told me that the physician who operated on me
continues to remove way too much tissue, and is dogmatic in his
approach.
 My husband had a serious parotid gland problem: and was operated on
by the former head of head and neck surgery at Mass Eye and Ear: Dr.
Richard Fabian, and he was beyond wonderful. He retired to Florida, and
my husband sees his younger associated, Dr. Derrick Lin--a very nice
person and physician. I found both Dr. Fabian and Dr. Lin to have a
lack of ego that is refreshing. (When my husband developed a salivary
abscess, I mentioned that a family friend had a similar problem after a
face lift, and used a scopalmine patch--and the head of surgery at Mass
Eye and Ear told me that was a brilliant suggetion--and it worked. Ten
years after removing his parotid, my husband's gland still acts up, and
Dr. Lin told him, that he had stumped the previous world expert, and
agreed to work with him to figure out a solution.) I did ask them who
the current sinus surgeons were at Mass Eye and Ear and they
mentioned:Stacey Gray or Eric Holbrook.
 So, I don't know the ENT you were referred to, but these were my
experiences at Lahey and Mass Eye and Ear. (I have an otologist at Mass
Eye and Ear who is wonderful: Steven Rauch.)
 Good luck and I hope your marathon infection clears up.
Judy