From the Guidelines
For a deviated septum with chronic sinus pressure and new right ear pain that hasn't responded to cefdinir, doxycycline, Atrovent nasal spray, or Flonase, I strongly recommend seeking evaluation by an otolaryngologist (ENT specialist) for potential surgical intervention, as this is likely the most effective way to address the underlying anatomical issue and improve symptoms. This persistent condition requires a comprehensive assessment to determine the best course of treatment. In the meantime, you could try a different nasal steroid like budesonide (Rhinocort) once daily, saline nasal irrigation twice daily using a neti pot or NeilMed system, and over-the-counter pain relievers such as ibuprofen (400-600mg every 6-8 hours with food) for pain and inflammation, as recommended by the clinical practice guideline update for adult sinusitis 1.
The new ear pain suggests possible eustachian tube dysfunction or middle ear involvement, which may require specific treatment like pseudoephedrine (30-60mg every 4-6 hours, not exceeding 240mg daily) for short-term relief of congestion. Antibiotics haven't helped because your condition may be structural rather than infectious, or you might have a resistant organism or fungal sinusitis requiring different antimicrobial therapy. The deviated septum physically obstructs normal sinus drainage, creating a cycle of inflammation and pressure that won't fully resolve without addressing the anatomical issue, as discussed in the diagnosis and management of rhinitis study 1.
According to the ACR appropriateness criteria for sinonasal disease, functional endoscopic sinus surgery is now the standard of care for restoring patency of paranasal sinus outflow tracts, with postoperative improvement in symptoms and quality of life reported in over 75% of patients 1. This suggests that surgical intervention may be a highly effective treatment option for your condition.
Key points to consider:
- Seek evaluation by an otolaryngologist (ENT specialist) for potential surgical intervention
- Try a different nasal steroid like budesonide (Rhinocort) once daily
- Use saline nasal irrigation twice daily using a neti pot or NeilMed system
- Take over-the-counter pain relievers such as ibuprofen (400-600mg every 6-8 hours with food) for pain and inflammation
- Consider pseudoephedrine (30-60mg every 4-6 hours, not exceeding 240mg daily) for short-term relief of congestion if eustachian tube dysfunction or middle ear involvement is suspected.
From the Research
Deviated Septum and Chronic Sinus Pressure
- A deviated septum may be associated with chronic sinusitis, but the relationship between the two is not fully understood 2, 3, 4, 5.
- Some studies suggest that a deviated septum can cause mechanical obstruction of the ostiomeatal complex, leading to sinusitis 2, 4.
- However, other studies have found no significant correlation between septal deviation and the severity of sinus disease 3.
Treatment of Deviated Septum and Chronic Sinus Pressure
- Septoplasty may be performed to relieve nasal obstruction and improve surgical access to the ethmoid sinus, but its effect on chronic sinusitis is unclear 2.
- Medical treatment, such as antibiotics and nasal sprays, may be used to manage symptoms of chronic sinusitis, but may not address the underlying cause of the deviated septum 2, 3, 4, 5.
Relationship between Deviated Septum and Middle Ear Pressure
- There is evidence to suggest that a deviated nasal septum may be associated with middle ear problems, particularly on the side of nasal obstruction 6.
- Middle ear pressure has been shown to improve following septal surgery, and is inversely related to the difference in patencies between the two nasal passages 6.
Right Ear Pain
- The relationship between a deviated septum and right ear pain is not well established, but it is possible that the deviated septum may be contributing to Eustachian tube dysfunction, leading to middle ear problems 6.
- Further evaluation and treatment by an ear, nose, and throat (ENT) specialist may be necessary to determine the cause of the right ear pain and develop an appropriate treatment plan.