So what do I think is the source of my chronic rhinosinusitis? The current thinking by my ENT is that I am colonized in the frontal sinus region by Pseudomonas Aeruginosa (a gram negative biofilm). Evidently this is not uncommon for patients fighting sinus infections that may have taken multiple rounds of antibiotics.
Apparently, it is common for allergies to be heightened when colonized by a bacteria. This would explain why I seem to have different sensitivities/ inflammation on a daily basis. Sometimes it feels like I'm allergic to everything (pollen, pollution, etc.) even though my allergist says I'm only allergic to mold (based on repeated skin tests). The problem is that my frontal sinus opening is small and my anatomy restricts the size of the opening via any enlargement surgery. It only takes a mild allergic reaction for my frontal sinus opening to close up almost completely. Since the frontal sinus opening is rarely open all the way - sinus irrigation is unable to penetrate into my frontal sinus cavity on a consistent basis. This, I currently believe is the source of my complications.
So... all of this agrees with the varying symptoms I experience on a daily basis. Does this sound familiar to any of you?
Now, if I could find the right balance of medications and supplements to open my frontal sinus completely and keep it open for more than 2 weeks in succession, then I might have a chance to reduce the level of colonization by using nasal rinses. Otherwise, I am unlikely to see major improvement.
There is one way to irrigate the frontal sinus... The frontal sinus can be "power washed" using a sinus irrigation catheter, though this is currently performed only as a surgical procedure. What I think might help is if deep frontal sinus irrigation could be performed more regularly, perhaps twice or 3 times a week. This would deliver the appropriate solution to the frontal sinus on a consistent basis and perhaps reduce the level of colonization. But once again, this is a surgical procedure which by definition cannot be done on a regular basis due to a number of issues. One issue is that the sinus tissue would be traumatized from this type of invasive procedure. The tissue can take days or even weeks to recover from the trauma of surgery.