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Sphenoid sinusitis and PANDAS

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The sphenoid sinuses are way back near the pituitary gland and are very hard to treat without IV antibiotics, because they are so isolated. My son appears to have one of these lovely, uncommon infections. Our pediatrician referred us to an ENT. He's had the infection for a month, and it went away, just a little, for a week with augmentin. He has had PANDAS symptoms along with it--OCD, ADHD, ODD, separation anxiety, pee obsessions, etc. We're on this.

It may be far fetched, but could the autoimmune reaction to strep start in these sinuses and make it's way to the basal ganglia through this area? These sinuses have a few tiny blood vessel connections to the brain and can cause menangitis, so what about PANDAS???

Any thoughts??

Thank you in advance.

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case 4. Because of the persistence of debilitating psychiatric symptoms for 2 months, the patient opted to go through with sinus cyst removal and turbinate resection and reduction. Immediately following the surgery, she experienced an almost complete remission of her psychiatric symptoms, including her OCD and mood symptoms. She reported that, “They pulled the OCD right out of me when they pulled out the cyst!” 

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Hi Mark,

Did you already have treatment for the sphenoid sinusitis?

For both my kids, an acute sinusitis flare of their chronic sinusitis was a major trigger for a severe PANS flare.... and the chronic sinusitis meant that any small cold immediately turned into acute sinusitis.  

However, the right antibiotics can still take care of a sphenoid infection; so it's certainly not that you have to have surgery.  

For DS#1, he was on a 3rd gen antibioticsfor months, and even after sinus and sleep apnea surgeries continued having this sinusitis and feeling exhausted.  Then I took him to an ENT who strongly believes in culture-guided antibiotic therapy, he did an endoscopic exam, found some mucus far back, cultured it -- and found that it was mostly or completely resistant to all the Biaxin, Ceftin, even quinolone antibiotics we'd been using, but quite sensitive to lowly Augmentin, which he'd not had for years.  Or perhaps even amoxicillin.  A 7-day course of that antibiotic and my son felt SO much better.

In contrast, with DS#2, we never found a magic antibiotic, so he'd get 50-70% better and then stall.  What helped him were 4 courses of IVIG, after which colds no longer caused major flares. (My lay theory is that the foreign antibodies were better at recognizing and fighting the bugs he had than his own antibodies).  However what seemed to really cure him of the sinusitis was treatment for tick-borne infections, for which he was on double antibiotics for a few months, including things like doxycycline and rifampin.  He's now been off all antibiotics for 18 months (that was scary for me), and instead simply takes probiotics, VitD3 Co-Q10 and other vitamins, and some anti-inflammatory herbs (turmeric, quercetin....).  DS#2 has had a few colds that have not turned into sinus infections.  A mild flare with the last cold last winter (and that was a particularly nasty cold, as both I and his friend can attest).

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