instruction: hello doctor I have a history of sinusitis last year I had chronic sinus symptoms and got a it scan it showed nasal septum deviation blocked maxillary and frontal sinusitis due to nasal polyps I got a fess and septoplasty done this year the symptoms reappeared strongly I have severe headaches facial pressure nasal discharge and pain in jaws and ears along with that I have a frequent infection in sinuses and have done an antibiotic course four times in three months I got a it scan and it shows complete pacification of maxillary sinus little ethmoid sinus and hypertrophy of nasal turbinates I am using nasonex steroid spray twice a day getting nasal rinse done repeatedly with saline water I am taking steam and anti histamine before sleeping but not getting better please help
output: hello welcome to icliniq com I shall tweak your medicines a bit and let us see if that gets you an improvement change the antihistaminic to one with montelukast say like levocetirizine or fexofenadine plus montelukast 10 my take this once daily take another antihistamine different from above at a different time daily that means you will be getting two antihistamines per day and one with montelukast combination take a short course of deflazacort my twice daily take the same for five days and taper it to once daily for the next five days use the nasonex mometasone furoate spray appropriately twice daily there are particular instructions as to using the spray it has to be held in a particular way and sprayed if you have thick nasal discharge or fever or throat pain it is prudent to add an antibiotic preferably clarithromycin 500 my twice daily for five days let us know the progress with these medicines please upload previous and current it scan films to us when you write to us the next time do provide all previous treatment records and medication details when you get back