People with superesophageal or Silent Reflux (stomach acid coming up above the esophagus into the throat and back of nose) usually don’t experience heartburn or indigestion. Instead, other symptoms such as hoarseness, coughing and excessive phlegm, constant throat clearing, choking, burning sensation and the feeling of stomach contents coming up are typical. Nasal endoscopic examination of the larynx (voice box) and the nearby inlet to the upper esophagus is usually employed to confirm the diagnosis of this type of reflux. In some cases actual 24 hour pH testing is performed by putting a probe in the nose the nose so that the stomach acid coming up into the nose can actually be measured. In some cases the pH test is performed while the patient is taking anti-reflux medication, to make sure that antacid treatment is effective in eliminating the acid reflux.
Other options include cephalosporins such as cefpodoxime proxetil (Vantin) and cefuroxime (Ceftin). In patients allergic to beta-lactams, trimethoprim-sulfamethoxazole (Bactrim), clarithromycin (Biaxin), and azithromycin (Zithromax) may be prescribed but might not be adequate coverage for H. influenzae or resistant S. pneumoniae . 16 Penicillin, erythromycin (Suprax), and first-generation cephalosporins such as cephalexin (Keflex, Keftab) are not recommended for treating acute sinusitis because of inadequate antimicrobial coverage of the major organisms.