Brief Answer:
Further evaluation needed.

Detailed Answer:

Hello,

From your attached picture, yes, some swelling is still visible there.

First of all, please note when there's persistence of pain and swelling despite antibiotics therapy (I believe you might've consulted a physician before initiating them) there's further investigations and aggressive management required.

At this outset, I'd suggest getting a detailed ENT check-up as this is mostly pointing towards an ongoing sinus problem (sinusitis most likely). I'd suggest going for the CT scan of the paranasal sinuses along with a few other investigations (CBC, ESR, Serum IgE levels and a few others) to look into it in detail.

Please discuss this with the ENT specialist and proceed further. Treatment is mainly based on the findings, and may well be consisting of long-term broad-spectrum antibiotics and anti-allergic and other supportive medications.

Apart from gargling and hot compression, drink plenty lukewarm liquids (soups, broths, herbal tea etc.) throughout the day, avoid direct exposure to dusty/cold air, stay away from over-crowded places, take steam inhalation thrice daily, it'll provide some symptomatic relief.

Hope I have answered your query. Please let me know if I can assist you further.

Take care.

Regards,
Dr. Arnab Banerjee
Critical Care Specialist

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Brief Answer:
Follow-up consultation

Detailed Answer:

Hello,

Good to know you've already done those investigations. Could you please upload the reports?

Kindly let me know if you've consulted any ENT yet. If yes, what was the initial finding, you can upload some snapshots of the prescriptions if any.

It may or may not be related to bacterial infections (although the bacterial infection mostly presents like this) as you may be knowing that there are several other different entities of infections (most notably viral as well as fungal, protozoal and a few others).

Since right maxillary sinusitis is already documented, it'll be important to find out what's causing it (infection, inflammation: due to any allergic responses, or some other reasons). This is why I'm once again suggesting you get a thorough ENT check-up in the first place. The clean nose may or may not be related to this at all (because there are several other entities where similar findings can be present despite a clean nose).

Hope I have answered your query. Please let me know if I can assist you further.

Take care.

Regards,
Dr. Arnab Banerjee
Critical Care Specialist

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Brief Answer:
You should be checked up by an ENT specialist as already explained.

Detailed Answer:

Hello,

First of all, please note, you should not take different antibiotics without a proper check-up. Unsupervised use can not only prolong the presenting complaints but also can produce unnecessary microbial resistance (always remember, symptoms may or may not be identical, but diagnosis can be different which is why a proper clinical check-up is ideal before starting any antibiotics).

Coming to your query, Azithromycin, in some selected scenario can be taken up to 3 weeks or so (without any interruption), but it needs to be diagnosed at first.

Since you're getting fever again, do look for the swelling, and check if it's appearing red/inflamed/painful to touch or increasing in size- if it is, the chance of an impending abscess formation is more, and it requires immediate aggressive antibiotic therapy for prolonged time course and/ a small incision and drainage procedure (again, done by the ENT specialist or a Maxillofacial Surgeon).

However, as you've mentioned that you're already taking Fluticasone and Montelukast for past 20 days, another allergic outbreak may not be the case here. You can always opt for a second opinion in this case (but make sure to consult an ENT specialist only).

I'd strongly advise you to go for the ENT check-up without any further delay.

Let me know how you stay in the due course. Hope I have answered your query.

Take care.

Regards,
Dr. Arnab Banerjee
Critical Care Specialist

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