Suggest Treatment For Severe Nasal Congestion Caused By Vasomotor Rhinitis
What could be doing this and why is nothing helping? ENT doc mentioned I have a slight deviation in my septum but due to how this just came about suddenly he did not feel that was even contributing to this. What are your thoughts on this, and what can I do to get my nasal passages to stop swelling? The only thing I can think of was that I cried when I was laying down when I pulled my back and then all this started. Granted we were cleaning some in the house too and that may have contributed too, I just do not know but shouldn't this has went away by now? Any suggestions? Oh, I was on zyrtec for 5 years for skin itching I would get(I am sensitive to things and will get odd rashes or itchiness from medications or just out of nowhere so my allergist told me to take the zyrtec a few years back), a low dose only 5mg a day. When this all started I was on the 5mg of zyrtec so I figured it could not be an allergy as the zyrtec would have helped or even prevented it. I since have stopped the zyrtec 2 weeks ago just to see if maybe it was causing my nasal passages to be more dry and causing this but I am still the same, no change. Any suggestions or ideas of what could be happening here??
Intrinsic / Vasomotor Rhinitis, Rule out NARES.
Detailed Answer:
Hi,
Thank you for your query.
1. This history and symptoms suggest the possibility of Intrinsic / Vasomotor Rhinitis. NARES (Non Allergic Rhinitis with Eosinophila Syndrome) should be ruled out.
2. The exposure to odors, fumes, the stress of the muscle injury, shifting to a new home, any medication for this injury (drug induced by anti-inflammatory medication or rebound from decongestants) are causes of Intrinsic / Vasomotor Rhinitis.
3. There may be a component of dust allergy (Mixed Rhinitis). Hormonal changes due to stress may also contribute.
4. Nasal steroids, nebulization are usually helpful. If not, you can start with a combination of an anti-histamine and an anti-leukotriene. Most patients will respond to medical treatment. A few need nasal turbinate reduction by radiofrequency, coblation or other surgical techniques.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
I have had this for just little over a month now and it started out of the blue, like all of a sudden. Would you think this is too early for surgery? also, when is this considered Chronic? When researching on the Internet, I have come across some sites that state if swelling and congestion of the turbinates do not get better then it will be permanent. This is scary. How long does it take for it to be considered " long term" to where the trubinates are permanently damaged to where they wont shrink on their own again? I asked my primary care doctor about this and she said it is not true and it would take years for it do this. What is your opinion on this?
If this was caused by breathing in dust/or mold spores from when cleaning( though I never saw any kind of mold but have read you can have mold hidden in places to where it will release spores and toxins and it can affect people who are sensitive to it) wouldn't this have passed by now since we are not doing any work in the house anymore?
Lastly, can stress cause this? If so, how do I remedy it or what could I take to help with this?
Details as discussed below:
Detailed Answer:
Hi,
Thank you for writing back.
1. NSAIDs are one of the many causes for Vasomotor/ Intrinsic / Non Allergic Rhinitis.
2. Nasal steroids require 5 to 7 days of regular use to reach effective action.
3. Pseudoephedrine is a decongestant with a rebound action even if taken every alternate day.
4. Vasomotor / Intrinsic / Non-allergic Rhinitis can appear suddenly.
5. Nasal turbinate hypertrophy can be considered chronic if there is no relief after 6 to 8 weeks of treatment.
6. This is very common and most cases respond to medical treatment. A few need nasal turbinate reduction by radiofrequency, coblation or other surgical techniques.
7. The stress of the earlier situation may have precipitated this. Part was from the injury. There can be added mold and dust allergy (Mixed Rhinitis).
8. The nasal washes should be with hypertonic saline (2%) and not with distilled water.
9. Get an ENT Consultation from a specialist who has experience in handling these conditions. You will get relief.
10. If this is not possible, request a pre and post decongestion plain Sinus CT. After the first Sinus CT, use 5-8 drops of Otrivin (0.1% Xylometazoline) nasal drops on both sides. Repeat the Sinus CT after 15 minutes. Compare the images with any change in the nasal obstruction. The radiologist has to reduce the scanner settings to halve the radiation dose. Upload the images here or directly at bit.ly/Dr-Sumit-Bhatti
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
Rhinitis Medicamentosa.
Detailed Answer:
Hi,
Thank you for writing back.
1. Pseudoephedrine causes rebound congestion. The condition is known as Rhinitis Medicamentosa.
2. This is unlikely to be an infection, but it can be an allergic reaction to a fungus.
3. Treatment of Non allergic rhinitis is similar. It includes anti histamine nasal sprays (such as azelastine) and steroid nasal sprays, saline nasal washes and oral decongestants (such as pseudoephedrine, which explains the improvement). Besides these, there are surgical treatments as mentioned earlier.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.