Medical Management

Patients who have evidence of purulent secretions at surgery are advised to take a broad-spectrum antibiotic with anaerobic cover for 2 weeks, unless a culture suggests a different spectrum of sensitivity. Patients are advised that they may have loose stools toward the end of the course of treatment. Women are warned that they may get vaginal thrush toward the end of treatment and require an antifungal pessary. They are also warned that antibiotics can interfere with the absorption of the contraceptive pill.

Patients with allergic rhinitis are advised to continue their topical nasal steroid therapy after douching and to follow their preoperative treatment strategy (e.g., allergen avoidance, antihistamines).

Nasal drops enter the frontal sinus best if they are given with the patient lying flat and with their head cocked back over the edge of the bed. It is often difficult for a patient to gauge how many drops they have instilled in this position and it can be helpful to keep the drops in the fridge, so as to provide more sensation when they are put in. As with all patients with allergic rhinitis, the importance of compliance should be explained. In patients with nasal polyposis, topical nasal steroids are given for 3 months and then reduced if the mucosa looks healthy (Fig. 13.4). In patients with allergic aspergillosis or invasive aspergillosis, itraconazole is preferable to amphotericin as it is associated with fewer side effects. Nevertheless, liver function and morning cortisol levels should be monitored monthly.

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