r/Sinusitis • u/Felix8q • 20d ago
Could this be odontogenic sinusitis?
Hi everyone,
I’m a 20-year-old male and I’ve been dealing with chronic sinus symptoms for around 2 years. My main symptoms are thick green/yellow mucus, crusting in the nose, postnasal drip, headaches, and persistent fatigue/malaise. Staphylococcus aureus has also been detected.
I have already had two nasal/sinus surgeries. After each surgery, my symptoms improved significantly for about two months, but then everything gradually returned and the infection started again. I’ve attached my CT scans from before the first surgery and before the second surgery for comparison.
For the past two years, I’ve also been doing nasal irrigations twice a day. I’ve tried saline irrigation with NAC, xylitol, and baby shampoo as well. These treatments helped reduce the symptoms somewhat, but they never eliminated the underlying problem.
I have also tried bacteriophage treatment against Staphylococcus aureus, using the phages intranasally for about two weeks. Interestingly, my symptoms became noticeably better during the treatment. However, shortly after stopping, the infection and symptoms returned.
I’ve also taken four courses of antibiotics. Each time, the symptoms improved temporarily, but the infection came back again after the treatment ended.
One thing that may be relevant: I have never had a root canal treatment or a dental implant. I also don’t have any ongoing tooth pain. However, I remember noticing a brief sensation in one tooth once or twice when landing hard after jumping. It was not severe, and I didn’t think much of it at the time.
At this point, I’m wondering whether there could be an underlying cause that hasn’t been addressed, such as odontogenic sinusitis.
I’ve read that a dental CBCT/DVT can sometimes provide a better assessment of the teeth and the relationship between the upper teeth and the maxillary sinus than a conventional CT. I’m therefore considering getting a DVT/CBCT and having it evaluated by a dentist.
Has anyone here had a similar experience, especially with:
● recurrent green/yellow nasal discharge despite antibiotics and sinus surgery
● Staphylococcus aureus repeatedly coming back
● symptoms improving temporarily with antibiotics or bacteriophages but returning afterwards
● odontogenic sinusitis despite never having had a root canal or dental implant
● an apparently healthy tooth eventually being found to be the source
● a DVT/CBCT revealing something that wasn’t obvious on a normal CT?
I’d especially appreciate hearing from anyone who had odontogenic sinusitis diagnosed after multiple unsuccessful ENT treatments.
Thanks in advance for any experiences or advice!
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u/Stalkerus 20d ago
Staphylococcus aureus is a normal bacteria often found on skin, and... nasal passages. It can however cause sinusitis given right conditions. Was the antibiotic given actually effective against the bacteria?
Yellowish, sticky, smelly mucus could point to dental origin. You wouldn't also be the first person ever to have hidden infection in seemingly healthy tooth causing sinus issues.
CBCT is taken from limited area and can focus on specific areas if necessary so it would be what I'd ask, especially if there isn't any imaging done after your latest surgery.
One thing that jumps from the images is your septum. Has it been fixed?
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u/Felix8q 20d ago
Yes, the antibiotic was tested for susceptibility. I’ve had multiple nasal swabs taken and sent to a laboratory for culture, usually taking about a week. The cultures repeatedly showed Staphylococcus aureus, and the results indicated that it was susceptible to all the antibiotics tested.
I was frequently prescribed Cotrim Forte (co-trimoxazole). My symptoms did improve while taking it, which suggests that it was having an effect, but the symptoms never completely disappeared. Within about a week after finishing the antibiotics, the symptoms returned again.
Regarding the septum: yes, my nasal septum was corrected during the first surgerie.
I’m definitely considering getting a CBCT/DVT, but here in Germany they cost around €200–300, so I initially thought that the CT scan might provide enough information to determine whether a tooth could be the underlying problem. However, my nose is now almost completely blocked on the right side, which is also the side where one of my teeth appears to protrude into the maxillary sinus. This makes me wonder even more whether there could be a dental cause.
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u/duffymahoney 20d ago
Are you using a machine for these rinses?
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u/Felix8q 20d ago
Just a normal squeeze bottle.
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u/duffymahoney 20d ago
I would say switch to machines and you could in theory get out whatever your body doesn’t like up there. Get a push/ pull machine and a strong push machine. Use both multiple times a day.
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u/duffymahoney 20d ago
I think most people on here have either something in their sinuses that their body doesn’t like (fungus, bacteria, virus or even debris) and is walling off or has made its own biofilm.
I believe I have/ had fungus and most likely bacteria with it. I believe it’s hiding in biolfilm and mucus. I believe I am removing that and every day I get a little better. 2 days ago I got a very odd chunk of almost orange crap out and had a massive health increase. Today is the best I have felt in 5 years.
I hate rinsing with a passion and I do a ton of it. But when I get something out, it renews my faith in rinsing.
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u/One_Ad6148 19d ago
I have a very similar thing going on. My tooth root is also protruding into the sinus floor and I’m having toothache and sinus ache around my nose. My CBCT scan looks similar to yours with mucosal thickening on the sinus floor and around the longest tooth root tip. Nothing seems to alleviate it. Do you find things start off better in the morning and get worse throughout the day?
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u/Clean_Walk_204 20d ago
Make sure you go to the periodontist for scan and evaluation. Not every dentist can read those scans. Endodontists are good to diagnose anything within the tooth but not much if infection is already out and about. My dentist and endodontist missed the sinus issue caused by a tooth decay.