Is It Sinus Problem or Allergy

[seekinginfohelp]

Hello Doctor-
For a long time, perhaps 5-7 years, I have been feeling really tired.  I didn’t have energy to do anything after work and on weekends I had to rest a lot just to be ready to go to work.  

I had pains on the roof of my mouth and pain in my tongue-this is a big problem for me, morning fatigue as if I had not slept, popping ears, constant clear sinus drainage with black specks, mild headache around forehead, blurry vision and sensitivity to sun light, frequent low fever (thinking I may be coming down with a cold), etc.  I was in a lot of pain in my body, arms, neck, etc.  I also developed this brown patch spots around both of my eyes which I have been told may be related to allergies.  I saw many specialist including rheumatologist, GI specialist, but every doctor told me that I was fine.

About three months ago, I had was mildly sick with low fever but this time I noticed a terrible smell coming from my sinus.  My doctor checked my sinus and said my sinus was swollen and was put on antibiotics.  I was told to do nasal rinse everyday and I do the rinse twice a day and use Nasonex once a day.  I then saw a ENT specialist and he did a head CT which came out normal.  After the antibiotics for about two months, I felt so good as I have not felt in a long time.  I told everyone how good I was feeling.  About two weeks ago, I felt my body getting fatigued with body pain again.  I saw my doctor again and she again said that my nose is swollen.  

With all the specialists I have seen so far, no one can tell me who I need to see to get treated.  I thought that I had to live with my symptoms, but after feeling so great after the antibiotics, I know that I can feel better.  Can you please direct me to which specialist I need to see?  A different ENT, allergy specialist or anyone else?  Can you please tell me why I have this tongue pain (like it’s been burned and swollen)/roof of my mouth?

Thank you.  Desperately seeking doctor/Shirley

[seekinginfohelp]

The pain in my tongue is not acute pain and also it's daily pain for the last 2 years.  This pain started when I started taking an antidepressant.  I have been off of it for about 1 month.  It feels like it's swollen - like the surfact has been scalded.  It will hurt throughout the day but by the time I go home from work, the pain will go away.

I don't think think this is cold sore and I never had a cold sore around my mouth.  Can you tell me what cause this?  Thank you.

[David Tinkelman, M.D.]

Sore tongue can be seen with herpes virus (often referred to as “cold sores” but this infection usually shows an abnormal tongue surface.  Another condition associated with sore tongue is anemia secondary to deficiency of folic acid or vitamin B12.  You might want to consult a dermatologist about the sore tongue, and the sore tongue may be the key to diagnosing your underlying disease.

There are many causes of feeling tired including but not limited to:  chronic infection, autoimmune diseases, the chronic fatigue symptom (with or without firbromyalgia), and a variety of sleep disturbances including what is called obstructive sleep apnea.  The cause of your illness would most likely fall within these categories. It is telling, however, that you were seen by a Rheumatologist who did not find evidence of autoimmune disease or chronic fatigue with fibromyalgia.  The apparent response, of the malodorous material in your nose to antibiotics, strongly suggests that infection was a factor in that acute  illness, and it is possible to have (mostly) low grade infection of the sinuses or nose, with a normal or near normal sinus CT Scan.

Bacteria are the most common cause of sinusitis but fungi can cause either recurrent infectious or allergic disease of the sinuses and you might consider requesting a second, ENT opinion.

There is also the possibility of occult (not obvious) infection, elsewhere in your body.  If that were the case, your general physician would probably be able to locate and diagnose it

The apparent dramatic response of your underlying disease, to the two months of antibiotic is impressive. Should your symptoms persist, testing for infection and re-treatment with the antibiotic might be helpful.

I believe that a second opinion from a rheumatologist, a general Internist, and or an ENT with a special interest in mouth and throat disease would be most likely to provide a definitive diagnosis and allow for specific treatment.

Good luck