Chronic sinusitis and the Lily's saga

Lily was down with a bad case of sinusitis following her unfortunate encounters with several factors last month.  She was given a  two-day sick leave and a course of antibiotics when her nasal congestion was getting worse and sputum turning deep green. ( her case was related in my December 2009 posting).

She was back again at the clinic with a complaint of  pain in the left side of her chest. The pain was deep seated and not brought on by any exertion. She also described a blocked left side of her nose and a kind of discomfort in her left ear.

She then admitted that a few days after she stopped coughing in the last episode of her acute sinusitis, she went on a "langsat" eating spree. She ate the fruit almost everyday for lunch and after dinner. The fruit is in season now and sold almost everywhere at a cheap price. It is usually sweet but the fresh ones tend to be "sappy". The sap from the fruit can get stuck to the skin and obviously in Lily's case, on the surface of her throat and she started coughing again. early January. She did not want to see a doctor and began to self-medicate and drinking warm tea with lemon and honey. Her cough somewhat subsided but on the evening of 12 January felt the pain in her left chest and she came rushing to the clinic the next morning.

                                              Lily's favourite fruit, the Langsat

Having examined her, I excluded heart-related causes. I found out that her nasal septum is deviated to the left, hence the narrower nasal passage and she also chews her food on the left and swallowing on the left side of the food pipe. And so the left sided symptoms could be explained on this basis. All the while she had no fever to indicate a systemic involvement. I concluded that her left chest pain could have been a referred pain from the infected left sided sinus. It is important  to exclude any nastier causes such as a growth through a detailed history taking and examination.

Sinus infection lasting more than four weeks is a cause for concern. It did not help with Lily's daily gobbling on those sweet,watery and sappy "Langsat" fruit! I was worried the infection would worsen to involve other nearby structures and organ such as the trachea and the bronchus.  So I treated her as a case of chronic sinusitis with two types of antibiotics, one of aerobic (oxygen-dependent) bacteria and the other for anaerobes  (non oxygen-dependent). Such a mixture of bacteria is usually present in prolonged sinus infection.

Today Lily rang up to say that her chest pain has subsided and so as her nasal congestion and left ear discomfort. I was happy for her and advised her to continue with the antibiotic regime for the stated period and stay away from those "langsat"!