@Sarah_R Hoping Tonka had a peaceful last day and your heart is healing.
Thinking of you. Hang in there.
I am dealing with this issue currently. My 18 year old gelding started draining foul smelling discharge from left nostril first week in March. My usual vet practice was up to their eyeballs with foaling and I had to reach out to an unknown vet(but recommended by BO).
New vet is able to see my gelding on their way to another farm call. She explained a lot about sinus infections and put my gelding on a very expensive antibiotic. The drainage cleared up within 48 hours. It returned (without the stink) in three weeks after the round of antibiotics finished.
New vet came out and took rads. Nothing jumped out except for a lower sinus filled with pus. Teeth looked good and were all well seated in the jaw.
I had the new vet send all work, including culture results to my vet (who is part of a very large, well equipped practice). New rads showed infected root. My gelding went in last week and the tooth was pulled, the socket was packed and his sinus was flushed. The opening to flush is closed with five staples and looks really good.
I was very clear that the flap surgery was not something I could afford. So far so good. I have learned that sinus infections are really difficult. The bones degrade from infection that youāre not even aware of until the discharge starts. Things can go south quickly. Even after all this and close to $4,000 in vet bills, I might still need to euthanize him.
It just sucks. It is a difficult infection to fight. OP, I am so sorry.
Sheilah
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I just saw your post, Jingles for your horse. Iāve been through the sinus thing with one. I probably posted on this thread but I didnāt go back and check. Anyways, Jingling hard. Glad you got a culture, If I had pushed for one harder, it may have saved me a boat load of complications and further procedures. Hang in there.
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Idaho Rider the post above is for you, had difficulties trying to respond to your post but got it sorted.
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He is on his way back to the vet. His incision site blew up and is leaking pus. He is still on antibiotics and I am not sure he is going to make it through this. Nostril has no discharge, but what is leaking from the incision looks and smells like the nasal discharge from before the flush.
I donāt want to be pessimistic, but it does not look good. This poor horse has been on antibiotics since the first week in March, off and on. He should not need another flush less than a week after the first one.
Sheilah
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Iām sorry. Sending more jingles for you and him. This happened to my mini too. They cleaned up the incision and thatās when they changed his antibiotics. A lavage system was put in so we flushed him at home for about a week. Itās rough all around and the expense makes the decisions difficult. I know how hard this is and Iāll be thinking of you.
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I am jingling for you and your horse. Iām pretty sure I posted upthread about my frustrating battle with my Hackney ponyās sinus problems. It broke my heart to have to let him go, but he was 29 and I could not get him comfortable. We tried so hard.
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Max did not make it. The infection had gotten much worse, despite everything and I made the decision to let him go. He had been bright and happy up until today. He was just done.
Max was such a sweet, gentle soul. He deserved to not be in pain. My vet agreed it was time to let him go. My heart is broken
Sheilah
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Iām so sorry to hear this, and the OPās story too. I didnāt see this thread until today.
Big hugs and jingles to you both 
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I am so sorry.
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I am so sorry for your loss. Max sounded like a real sweetheart. Those ones really hurt.
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I am so sorry to hear this. Godspeed Max.
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{{{Idaho Rider}}}
Godspeed Max.
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