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Cold symptoms and congestion/fluid in ear for 10 weeks
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Mr_Angry posted:
For the past 10 weeks I've had on and off again symptoms where it feels like I have had a persistent cold that will just not go away. I have sinus congestion and on occasion some mild pressure in the nose with slight headaches and a persistent post-nasal drip. In addition my ears are congested--I can go 2-3 weeks without any problems but then I get symptoms where it feels like there is fluid and swelling in my ears.

I have seen both a general doctor and an ENT specialist and in both cases they have stated that while they see some very mild inflammation my ear pressure is normal and there is no fluid or infection present in the inner ear. I'm fine with that and don't wish to take anti-biotic unless it is absolutely necessary (and if the problem is viral it wouldn't help to begin with) but I'm tired of these symptoms going on for as many weeks as they have and sometimes it is difficult to sleep when I have frequent post-nasal drip.

I've been taking OTC medication such as Sudafed when needed but is there anything in addition I can do here? Do I really just have a persistent cold or flu that just needs weeks to go away or do I have something else? An additional data point is two weeks ago I felt fine but on the weekend felt horrible, tired, achy and had a mild fever, all of which subsided 48 hours later. Now I'm back to a situation where I have a runny nose and fluid/swelling in my ears--any correlation?

Thank you for any help that can be provided.
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Rod Moser, PA, PhD responded:
Colds do not last ten weeks, unless of course you are constantly exposed to them (like children) and they become "back to back". A typical viral infection lasts about a week. When you have persistent symptoms like you are describing, you may want to consider allergy, chronic sinusitis, etc. This may require some additional diagnostic tests to determine. Since you mentioned a mild fever, secondary infections in the paranasal sinuses would be high on my list.

Sudafed does not help allergy. As a matter of fact, it can INCREASE post nasal drainage since it is a decongestant. Have you tried a long-acting antihistamine?

I really have no way to blindly diagnose you over the Internet, let alone offer patient specific treatments, so it is either back to the ENT for the "next step" (diagnostic tests), or see an allergist.
 
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Mr_Angry replied to Rod Moser, PA, PhD's response:
Thank you doctor, I have made another appointment with my ENT and will ask for some specific tests around sinusitis and such. I do not take antibiotics unless they are absolutely called for but perhaps with some tests we can determine a course of treatment with amoxicillin or something.

If this was something that had cleared up I would not give it any other thought but as I am into week 10 on this perhaps it is bacterial in nature. In thinking about it I did have tooth pain and had to have a filling replaced sometime before this whole incident started if that is any additional interesting information.
 
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Rod Moser, PA, PhD replied to Mr_Angry's response:
Yes...the tooth could somehow be contributory. Your ENT will be able to make that determination.
 
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Mr_Angry replied to Rod Moser, PA, PhD's response:
Thank you for the reply Dr. Moser; now that I've had various visits with my ENT doctor I have more information and I'm in the process of getting a second opinion but hope you could provide some additional insight.

My ENT doctor recommended I have a CT scan and the results showed I did have sinusitis (he referred to it as mild but being spread throughout my nasal cavity). The ENT doctor had already prescribed me a three day treatment of Zithromax (500 mg capsules) and was now recommending I have surgery to correct the problem. I said I was not comfortable having surgery and was wondering if there was any additional course of antibiotics I could take but he was persistent on surgery as he did not want me to just take antibiotics and build up a possible resistance. I understand the care taken when using antibiotics but surgery to me is a last option and for a mild form of sinusitis it seems too much. The ENT doctor said if I wasn't willing to consider surgery he said I should continue using Nasonex and if in three months I was still having problems to follow up with him for surgery but I mentioned I was going to get another opinion.

In addition my wife is exhibiting symptoms of what I have for more than two weeks and her doctor has given her a ten day prescription of penicillin. When my wife described the details of my treatment (we have the same doctor) he was surprised to hear surgery was even mentioned and recommended I follow back up with him and get the same ten day treatment of penicillin that my wife is now on.

My question Dr. Moser is given I have already had a three day treatment of Zithromax and am presently using Nasonex and taking a 10 mg tablet of Loratadin daily to keep symptoms at bay is there any other antibiotic you would recommend? I am going to make a follow up appointment with my current physician but as much as I am concerned (and disagree) with the ENT doctor's recommendation of surgery I also just don't want to take a "catch all" antibiotic like penicillin if something more targeted is warranted. There might come a time when I really need penicillin so I'd like to make sure I take it only when I have to versus something more specific that I could discuss with my present physician.

Thank you again.
 
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Mr_Angry replied to Mr_Angry's response:
My apologies, I forgot to add one piece of information. When I took the three day course of Zithromax I did feel remarkably better and had no symptoms but 3-4 days after I completed taking the Zithromax my symptoms began to return, albeit milder this time. I did mention this information to the ENT doctor but he still recommended surgery, hence my wanting to get a second opinion.

Thank you.
 
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Rod Moser, PA, PhD replied to Mr_Angry's response:
I am not a big fan of using short courses of antibiotics, especially Zithromax, for sinusitis. Studies have shown that most sinusitis is due to viruses, but since you have been having problems for so long, the chance of you having a secondary bacterial component is high. Plain 'ol penicillin is not the best choice either, but penicillin-like antibiotics (such as Augmentin) can be helpful, if you get the ENT or your primary care provider to prescribe them for you. Sinuses are bone, and the bones have a very poor blood supply. The only way for antibiotics to get in this area is via the blood, so stronger, or longer courses of antibiotics are often necessary if a bacterial sinusitis is being treated.

I am not sure if you need surgery or not, but I can appreciate your reluctance. You would need to see a different ENT for a second opinion -- someone who can examine you and review the CT scan. ENTs are surgeons, and surgeons do like to do surgery, so you can understand why he may think in this direction.
 
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Mr_Angry replied to Rod Moser, PA, PhD's response:
Dr. Moser,

I just wanted to provide an update on my symptoms in that my original doctor did some research and eventually prescribed Roxithromycin 150 mg twice a day for ten days (I realize this medicine is not available in the US but I live overseas in Europe). I took the medication as prescribed and after 6-7 days began to feel remarkably better but now that the prescription is over I feel the symptoms coming back on again.

At this point I'm concerned about taking more antibiotics as I don't wish to just have a resistance build up and am unsure of next steps. I am flying out over December so in the new year I will book an appointment with a different ENT to see about options but do you have any recommendations? Given I've taken Zithromax for three days and then Roxithromycin for ten days and still have symptoms (Sinusitis as far as my CT scan shows) I'm just unsure what to do next.

This is rather frustrating to me; I've never had this problem before and have been healthy but these cold like symptoms that I've had for six months now just show no signs of leaving and it is getting rather tiresome.

Any suggestions or recommendations that I could use to have a discussion with another ENT doctor would be appreciated.

Thank you.
 
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Rod Moser, PA, PhD replied to Mr_Angry's response:
Newer studies have implicated viruses as the primary cause of sinusitis so antibiotics are not needed in most cases, but there are still cases that have a bacterial component. In my own experience as a sinusitis victim, my own ENT insisted that I remain on antibiotics (I was on Augmentin, a penicillin based medication) for 12 weeks! I complained the entire time, but I did finally get better and for the first time in many years, I was sinusitis free. Everyone is different, of course, and every ENT treats sinusitis a bit differently. Whether you are a candidate for long-term treatment regime like the 12-week marathon that I endured, I can't say, but this would be something to discuss.


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