Persons who suffer from year round nasal congestion and post-nasal drip may be suffering from chronic nasal infections that have often gone undiagnosed for months, or even years. Clues to the presence of chronic sinusitis include a frequent early morning sore throat, halitosis (bad-breath) and an apparent lack of responsiveness to allergy medications. The absence of color in the nasal drainage is an unreliable indicator of the absence of chronic infections. In fact, many persons who see only clear nasal drainage are found, by CAT scan, to have chronic infections. Allergy testing is particularly important when nasal symptoms are year round because many non-seasonal allergens are environmentally avoidable (dust mites, pet dander, and indoor molds). Conversely, in persons with year round nasal symptoms, the lack of sensitivity to these non-seasonal allergens is an important clue suggesting the likely presence of an underlying chronic sinus infection. In our office, negative skin testing is the most frequent reason for recommending a sinus CAT scan evaluation.
The ear canals are structurally similar to the nasal sinuses and have and opening into the nasal cavity. It is rare for an ear infection to occur without a co-existing sinusitis. The main risk factors for recurrent ear and sinus infections are nasal allergies, sinus structural problems, and poor antibody protection (IgG and IgA) against bacterial infections.
When recurrent ear and sinus infections are noted in person over age 2, testing to confirm adequate immunity to a bacteria commonly involved in upper respiratory infections (Streptococcus pneumonia) is recommended. If poor protection is found, a vaccine PPSV-23 (commonly called the "pneumonia shot") can be used to correct this problem. In our experience, when immunity to Strep. pneumoniae is poor, PPSV-23 vaccination commonly stops the pattern of frequent infections in both children and adults.
We have also found that some chronic sinus infections are caused by multiple-drug resistant bacteria (MRSA or MDRSP) that are difficult to kill with many of the commonly prescribed antibiotics. Culture of nasal mucous has often proven helpful in identifying the presence of highly antibiotic resistant organisms. Your doctor should be concerned with finding the risk factors for recurrent infections rather than simply treating the infections when they occur.