How do I prove to my doctor that I have a sinus infection?

March 5, 2008 7:35 AM

How do I prove to my doctor that I have a sinus infection?

Now I know that typically, your average doc will go "does your head hurt a lot? feel pain in the jaw? tooth area? yellow or green mucus? painful sinus areas?"

And if you say "no" to all of the above, the likelihood of them wanting to give you antibiotics is nil.

However, I have experienced, previously, the same symptoms I've got now - TONS of drainage to throat, far beyond what i normally get from allergic symptoms (which I keep under control pretty much with regular allergy injections, saline rinsing and astelin nasal spray), and super heavy-feeling head. Of course, I don't have the green or yellow mucus. My current doc says the problem is just an allergy flare-up. I haven't had this problem much since I've had this allergist, so she doesn't see that I have previously had this occur. Usually it happens when I get a cold, and the cold goes away... then it turns into this. Of course I do every damn thing I can to prevent it, crank up the humidifier, go to sleep earlier, etc....

Sure, I know that there's the chance that taking the antibiotics could be coincidence in terms of eventual improvement, or the placebo effect... but after having something like this for a couple weeks, and nothing improving it, in the past, I have seen antibiotics do the trick.

And yeah, I could just go to another doctor.

But couldn't whether or not I have a sinus infection just be proven with a throat culture, and then we'd be done with this kind of argument? If not - WHAT is the 100% definitive way to tell if a person has a sinus infection other than the usual melange of symptoms?

posted by bitterkitten to health & fitness (17 comments total)

See if you can get him to order a CT scan. I've had several in the past to help diagnose sinusitis.
posted by cerebus19 at 7:38 AM on March 5, 2008

A CT scan is the normal way to determine this. If you have chronic sinusitis, ask for a referral to a specialist (either ear, nose, and throat or rhinology). Your specialist will order a CT if needed and likely stick a little fibre optic snake up your nose to have a look.
posted by ssg at 7:42 AM on March 5, 2008

Can't you just ask him for a prescription anyway?
posted by frieze at 8:48 AM on March 5, 2008

Can't you just ask him for a prescription anyway?

That kind of shotgun approach to antibiotic prescribing is one reason we have MRSA.
posted by TedW at 9:10 AM on March 5, 2008 [9 favorites]

frieze - I basically told this doc, who I've known for several years, "look, it's going to come down to whether you want to give me antibiotics or not. I'm pretty sure this is the problem, and I understand that doctors are more reticent these days to hand 'em out willy-nilly, so, what do you say?"

Doc said no.

Doc says it is possible this is caused by a sinus infection, but believes it is "extremely unlikely." It's been two days since I was there... I decided to wait to see if I was on crack, but nope, the problem is still there.

others - yep, I've been to ENTs in the past, who did cat scans, used the little snake thing, said things like "wow, how do you breathe out of that side of your face?" but ultimately told me "stick with the allergy shots". And I've been pretty much ok, outside of things like this occurring here and there. There were of course fixed.... with antibiotics.
posted by bitterkitten at 9:11 AM on March 5, 2008

This isn't really something you prove to your doctor. Besides which, your doctor probably knows that the current literature advises against antibiotics for sinus infections.

You say she doesn't know your history. You should rectify that, so that she can make good, informed recommendations for your care going forward. Why not request that your medical records from previous docs be forwarded to her?
posted by caitlinb at 9:24 AM on March 5, 2008

If you haven't already, explain that you've had a sinus infection before, then as now it did not match the textbook symptoms, but it was a distinctive experience and you know it when it's happening. If your doctor doesn't initially trust you, or respect your judgement, then while discussing the test cerebus mentions, ask if (s)he will take your word for it in future if you have this unlikely diagnosis confirmed against all odds. If so, then the test may be worthwhile as an exercise in getting your doctor to know and trust your judgement. If not, you've probably got a bad doctor.

Going to another doctor may be a short term option but is broadly a bad idea in the sense that it's what got you in this mess - keeping the same doctor for many many years builds a relationship where they know you, know how you differ from the textbook, know when to trust your judgement and when to ignore it, etc. If you already had that relationship with your doctor, you wouldn't need a test to show them what you already know.
posted by -harlequin- at 9:30 AM on March 5, 2008

Hm. Caitlinb - if the current literature advises against antibiotics for sinus infections - what DOES it advise? Hell, I'll try anything reasonable, I'm really a proactive patient that way. : )
posted by bitterkitten at 9:59 AM on March 5, 2008

Try NeilMed Sinus Rinse. I've had many sinus infections over the years that have been treated with steroids and antibiotics. My doctor became reluctant to proscribe that course of treatment as well, and suggested the sinus rinse. It takes a bit of getting used to, it's similar to a neti pot but with a little pressure added, but works well.
posted by lunaazul at 10:35 AM on March 5, 2008

I have terrible head allergies. At one point a doctor suggested I get in the habit of sucking water through my nose while showering and flushing it out. Makes a huge difference. No drugs involved.
posted by GPF at 11:05 AM on March 5, 2008

I have terrible head allergies. At one point a doctor suggested I get in the habit of sucking water through my nose while showering and flushing it out. Makes a huge difference. No drugs involved.

That works better with a mild salt solution.
posted by Krrrlson at 11:16 AM on March 5, 2008

lunnazul - Yes. Just used it this morning -

"(which I keep under control pretty much with regular allergy injections, saline rinsing and astelin nasal spray"

been doing it for a while now, but stupidly I stopped at some point for a little and I suspect that's when I got the cold, followed by this.

So you've been able to annihilate sinus infections by using that? Of course I'll keep doing it.
posted by bitterkitten at 12:00 PM on March 5, 2008

So you've been able to annihilate sinus infections by using that?

Yes, by rinsing twice a day for about a week, once a day for another week, and then a maintenance program of once in a while after that. Like you, my colds turn into sinus infections too, but I've killed two of the nasty things that way in recent months. Good Luck!
posted by lunaazul at 1:03 PM on March 5, 2008

Going to my medical reference text, "Acute sinusitis is a disease that results from infection of one or more of the paranasal sinuses. A viral infection associated with the common cold is the most frequent etiology of acute sinusitis... Only a small percentage (approximately two percent) of viral rhinosinusitis is complicated by acute bacterial sinusitis. Uncomplicated viral rhinosinusitis usually resolves in seven to ten days... there appear to be no signs and symptoms of acute respiratory illness that are both sensitive and specific in making the distinction between bacterial and viral infection... Since rhinoviral infection typically improves in seven to ten days, the current consensus is that a patient with a cold or influenza-like illness that has persisted without improvement or has worsened over seven to ten days may have developed bacterial sinusitis (show table 3). In this subset of patients, the presence of nasal discharge, particularly if purulent, and/or maxillary pain or tenderness in the face or teeth, particularly if unilateral, is suggestive of acute bacterial sinusitis [13,14,22,23]. This type of presentation is common in acute community-acquired bacterial sinusitis, but some patients develop fever with facial pain, swelling, and erythema more acutely. In the latter patients, the diagnosis and treatment should not be delayed"

Hopefully this explains why your MD is taking the watch-and-wait approach (antibiotics will do nothing for your very-likely viral infection) and what to watch for a week or so after symptoms.
posted by a robot made out of meat at 1:26 PM on March 5, 2008

yellow or green mucus? This is a common myth. Yellow or green mucus is due to an increase in the number of white blood cells fighting an infection, not necessarily that it is of a bacterial nature.

And if you say "no" to all of the above, the likelihood of them wanting to give you antibiotics is nil. - The current recommendations are to wait 10d-2 weeks or until someone develops more severe symptoms then treat, unless you suspect acute bacterial sinusitis, then treat. Provide pain control and symptom relief, but not antibiotics.

Also, having post nasal drip (mucus down the back of your throat) does not a sinus infection make.

Gold standard for diagnosis is sinus aspirate culture, but more practical would be CT or MRI.
posted by gramcracker at 1:38 PM on March 5, 2008 [2 favorites]

Seconding meat robot- you may well have an infection, but it's probably a viral infection. Best treatment is your own immune system, primed with a moist environment and PLENTY of fluids, and maybe some NSAIDs to reduce inflamation. I'd ask for a culture as well just to be on the safe side, but my experience is that bacterial infections are far more acute in nature.
posted by gjc at 5:19 PM on March 5, 2008

neti pot. look into it.
posted by docpops at 6:07 PM on March 5, 2008