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Suggest Treatment For Cold And Allergic Rhinitis
Question: hi 2 years ago i had a cold which left me unable to smell and taste and feel congested after the cold had gone, eventually my GP referred me to to a ENT specialist. i was told it was due to allergies i think allergic rhinitis he gave me flixonase nasule drops but it took a few months to get better. recently i have had a cold and have had a similar problem, i went back to the specialist who looked in my nose and said my nose is inflamed and said it is due to allergies and not an infection. originally my gp prescribed amoxicillin for 5 days. the specialist has given me prednisolone 20mg for 10 days then 10mg for 10 days and said to carry on taking 400mg flixonase nasule drops along with cetrizine everyday.it is really depressing and i feel down as i can hardly taste and smell. the specialist said the prednisolone will make the inflammation go down and once that happens my smell will gradually return. im just paranoid and want to know if there is anything else i can do?, its been 4 days of taking the medicine and i do't feel like it has made much difference. how long will it take for my smell and taste to come back? and he also mentioned worse case he is going to see me for a follow up in 2 month and will look at the possibility of balloon sinuplasty if not. please could you help. Thanks
Brief Answer:
It will take a few weeks for the medication to help.
Detailed Answer:
Hi,
Thank you for your query.
1. The nasal steroid sprays take at least 7-10 days to begin their action.
2. The initial cold 2 years ago must have been the viral infection that damaged the sense of smell.
3. infection will not last so long, hence there must be allergy and inflammation.
4. Loss of smell leads to loss of flavour of food as in addition to the taste, the sense of smell is important.
5. A Sinus CT will show any inflammation and anatomical obstruction to the air reaching the olfactory epithelium in the roof of the nose and upper septum. An MRI Scan can be used to study the olfactory tract.
6. Balloon Sinuplasty will not be of any use here unless the CT Scan shows findings suggestive of associated sinusitis.
7. I would recommend high doses of multi-vitamins and neuro-protective drugs.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
It will take a few weeks for the medication to help.
Detailed Answer:
Hi,
Thank you for your query.
1. The nasal steroid sprays take at least 7-10 days to begin their action.
2. The initial cold 2 years ago must have been the viral infection that damaged the sense of smell.
3. infection will not last so long, hence there must be allergy and inflammation.
4. Loss of smell leads to loss of flavour of food as in addition to the taste, the sense of smell is important.
5. A Sinus CT will show any inflammation and anatomical obstruction to the air reaching the olfactory epithelium in the roof of the nose and upper septum. An MRI Scan can be used to study the olfactory tract.
6. Balloon Sinuplasty will not be of any use here unless the CT Scan shows findings suggestive of associated sinusitis.
7. I would recommend high doses of multi-vitamins and neuro-protective drugs.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
what kind of vitamins would you recommend to take and any other medicine to bring back my taste and smell? and how often. also is it normal for the prednisolone to not have kicked in yet? how long would you say it might take for the inflammation to go down and for my smell and taste to return.
Brief Answer:
Neuribion. Inflammation should settle in 4-6 weeks at the most.
Detailed Answer:
Hi,
Thank you for writing back.
1. Take Neurobion tablets twice a day.
2. The oral prednisolone will require more than 4 days to show full benefit.
3. The recovery of the sense of smell will ddepend on many factors. For example, how severe the original damage 2 years ago was.
4. It is important to check if you have 'hyposmia' (decrease sense of smell) or 'anosmia' (total loss of smell), and whether it is on both sides. The sense of taste should also be checked.
5. Any inflammation should take no longer than 4-6 weeks to settle down. If not, it should be investigated as above.
6. There is very little in terms of medical or surgical treatment for anosmia. You may wait for 4-6 weeks. Follow up here or directly at bit.ly/Dr-Sumit-Bhatti
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Neuribion. Inflammation should settle in 4-6 weeks at the most.
Detailed Answer:
Hi,
Thank you for writing back.
1. Take Neurobion tablets twice a day.
2. The oral prednisolone will require more than 4 days to show full benefit.
3. The recovery of the sense of smell will ddepend on many factors. For example, how severe the original damage 2 years ago was.
4. It is important to check if you have 'hyposmia' (decrease sense of smell) or 'anosmia' (total loss of smell), and whether it is on both sides. The sense of taste should also be checked.
5. Any inflammation should take no longer than 4-6 weeks to settle down. If not, it should be investigated as above.
6. There is very little in terms of medical or surgical treatment for anosmia. You may wait for 4-6 weeks. Follow up here or directly at bit.ly/Dr-Sumit-Bhatti
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
hi i can smell certain things to an extent if i put it close to my nose, other smells you would normally be able to smell are kind of diminished. so i think it is a decreased sense of smell. i have been told by the specialist he will see me in 2 months therefore should i finish the prednisolone and continue with the nasule drops until i next see him? Thank you i would just like to feel better again and want to know how long it will take. i understand it will require patience.
Brief Answer:
Hyposmia should recover in 4-6 weeks. Rule out NARES.
Detailed Answer:
Hi,
Thank you for writing back.
1. It is a good sign if you have 'hyposmia'. This increases the chances of recovery many fold as compared to any damage to the delicate olfactory pathway,
2. You should see an improvement in 4-6 weeks.
3. NARES (Non-allergic Rhinitis with Eosiniophilia Syndrome) is another type of chronic rhinitis in which a decreased sense of smell is seen. Nasal smear examination will be of use here.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Hyposmia should recover in 4-6 weeks. Rule out NARES.
Detailed Answer:
Hi,
Thank you for writing back.
1. It is a good sign if you have 'hyposmia'. This increases the chances of recovery many fold as compared to any damage to the delicate olfactory pathway,
2. You should see an improvement in 4-6 weeks.
3. NARES (Non-allergic Rhinitis with Eosiniophilia Syndrome) is another type of chronic rhinitis in which a decreased sense of smell is seen. Nasal smear examination will be of use here.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi so it's been 2 weeks since i have started to steroid nasule drops and have felt very little relief. i am on the 14th day of taking the prednisolone steroid tablets also. one of my nostril seems blocked most of the time while also getting nose bleeds on that side also what does this mean? the other nostril seems okay but i can still feel there is congestion and not be able to breathe 100% through them. i have been reading and i can feel that in that nostril the middle part of the nose is slightly pushed out however when i mentioned this to the ENT doctor i saw said that it isn't the issue. i am due to see my ENT on the 28th of February. it is just annoying as not being able to smell and taste properly. symptoms are some post nasal drip, slight sinus aches and itchy throat. i have bee taking Vitamin B complex tablets as we don't have neurobion tablets here in the U.K. while also taking levocetrizine and garlic tablets. is there anything i can do to resolve this issue quicker or is it just a matter of patience and waiting till i see the ENT specialist. My smell feels like it is getting better very very slightly.
Brief Answer:
Slight recovery is a good sign. Proceed with imaging as detailed.
Detailed Answer:
Hi,
Thank you for writing back.
1. If there is a slight improvement in your sense of smell. that is a good sign. If the damage to the olfactory system was severe two years ago, there would have been no recovery. Hence it will require patience.
2. This is the right time for you to do a plain CT PNS (Para Nasal Sinuses) with at least 1 mm coronal, axial and sagittal cuts. This should be followed by 5-8 drops of Otrivin (0.1% Xylometazoline) nasal drops in each nostril. After waiting for 15 minutes by the clock, repeat the plain CT PNS. A comparison of the images with co-relation with the improvement of your nasal congestion will help locate the site of the nasal obstruction, source of the post nasal drip, sinus aches and itchy throat. A limited MRI should also be done to check the olfactory bulb and tract in the brain.
3. If the decrease in smell is because of the nasal obstruction it will improve with treatment. This may be surgical depending upon your scan findings. A diagnostic nasal endoscopy should also be done.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Slight recovery is a good sign. Proceed with imaging as detailed.
Detailed Answer:
Hi,
Thank you for writing back.
1. If there is a slight improvement in your sense of smell. that is a good sign. If the damage to the olfactory system was severe two years ago, there would have been no recovery. Hence it will require patience.
2. This is the right time for you to do a plain CT PNS (Para Nasal Sinuses) with at least 1 mm coronal, axial and sagittal cuts. This should be followed by 5-8 drops of Otrivin (0.1% Xylometazoline) nasal drops in each nostril. After waiting for 15 minutes by the clock, repeat the plain CT PNS. A comparison of the images with co-relation with the improvement of your nasal congestion will help locate the site of the nasal obstruction, source of the post nasal drip, sinus aches and itchy throat. A limited MRI should also be done to check the olfactory bulb and tract in the brain.
3. If the decrease in smell is because of the nasal obstruction it will improve with treatment. This may be surgical depending upon your scan findings. A diagnostic nasal endoscopy should also be done.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Hi thanks for your reply. The follow up appointment i have isn't until the 28th February therefore should i just continue with the nasule drops until then and how long does it take for them to reduce the inflammation? or do you have any other recommandations. In regards to the scans and assesments you have mentioned can i ask the specialist to carry them out by request when i see him? As you know it is a furstrating problem and jist want it resolved. I also have ear pressure and pain at times too.
Brief Answer:
Continue medication. Get the scans done.
Detailed Answer:
Hi,
Thank you for writing back.
1. Continue with the flixonase till your appointment next month.
2. The inflammation takes many weeks to settle down since it has been there for a couple of years.
3. The scanning protocol will have to be explained to your specialist.
4. Ear pressure and pain signifies Eustachian Tube Dysfunction (ETD) which is probably due to chronic sinusitis and allergy. These changes will show up on the scan and can then be treated accordingly to speed up your recovery.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Continue medication. Get the scans done.
Detailed Answer:
Hi,
Thank you for writing back.
1. Continue with the flixonase till your appointment next month.
2. The inflammation takes many weeks to settle down since it has been there for a couple of years.
3. The scanning protocol will have to be explained to your specialist.
4. Ear pressure and pain signifies Eustachian Tube Dysfunction (ETD) which is probably due to chronic sinusitis and allergy. These changes will show up on the scan and can then be treated accordingly to speed up your recovery.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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