Brief Answer:
Additional measures, please provide more details

Detailed Answer:
Hello sir,

Thank you for asking at HCM.

I went through your history, reviewed your medications and understand your concern.

I would like to reply to your queries as follows:

1. For gagging sensation, I would think of two possibilities:

a. I would first think of post-nasal drip. It can be due to long standing rhinitis or associated sinusitis. Clue to it as a possibility is worsening of gagging with change in treatment of rhinitis (Qnasal spray).

Do you have feeling of something trickling from back of nose into throat? Do you have need to frequently clear throat? Do you have sense of fullness in nose even after using intranasal steroids and Claritin? Do you have symptoms like frequent headache, facial pain, facial heaviness, loss of smell?

Were I treating you, I would add montelukast to your treatment. Also, I usually suggest my patients with post-nasal drip frequent nasal irrigations with normal saline sprays as well as daily steam inhalation which may improve symptoms.

b. Second possibility I would think of is gastroesophageal reflux disease (GERD). Clue to it as a possible cause is worsening of gagging with coffee.

Were I treating you, I would suggest you to continue Prilosec along with avoidance of alcohol, caffeinated beverages, too hot and too spicy foods. I also suggest my such patients simple life style changes like having light meals in evening and going for a brief relaxing walk after evening meals.

I would like to know whether you have excessive salivation or feeling or watery brash/regurgitation in mouth. This may suggest possibility esophagitis.

Also, it is important to remember that both sinusitis and GERD can coexist together and GERD can worsen sinusitis.

2. As you were not comfortable with Qnasal spray, I would agree with changing back to old nasal spray (Fluticasone propionate) for rhinitis.

3. As mentioned above, alcohol can aggravate GERD/esophagitis. I would like to congratulate you for deciding to give up alcohol.

Apart from your queries, I would like to make a few suggestions to you as follows:

1. Regarding dizziness, there are many possible cause. But I would think first of ear related causes for dizziness. Clues to ear related dizziness are:

a. your dizziness improved after wax removal. b. your dizziness increases in closed moving vehicles such as car/plane. c. you have longstanding nose complaints.

Long-standing nose/sinus diseases can cause Eustachian tube dysfunction which can cause pathology in middle ear which can cause dizziness.

Were I treating you, I would suggest to get your ears examined by an otorhinolaryngologist at least every 3 to 6 months. This will help to identify any abnormality as well as to notice the changes that may occur with time.

2. Personally I would suggest you allergy testing which may help you identify the substances causing allergies to you and also to know the measures to avoid them. Avoidance is the best strategy in management of allergies.

3. Apart from above suggestions, I would mostly agree with your current medications. Please continue them under your doctor's guidance.

Hope above suggestions and information will be helpful to you.

Please feel free to ask any query on follow-up and also to provide further details asked above. It will be my humble pleasure to help with both my knowledge and efforts.

Wish you the the best of the health and a bright future ahead.

Thank you & Regards.

Dr. Parin N. Parmar

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Brief Answer:
going right way, have patience and precautions

Detailed Answer:
Hello sir,

Thank you for your follow-up and kind feedback.

I went through your details and am feeling you are on a right path.

In addition to previous reply, I would like to make following suggestions to you:

1. Please be patient with allergy shots. It make take a few weeks to a few months before you start feeling benefits of them, however, once benefits start, they usually last for long if you continue them as advised by your allergist.

2. Visiting an otolaryngologist is a good option in my opinion. It is important to understand that allergy shots treat the cause of post-nasal drip (allergic rhinitis) but not the post-nasal drip itself.

An otolaryngologist will examine your nasal cavity from inside to find out/rule out any structural cause contributing to your post-nasal drip and nasal congestion.

3. I would like to mention here that with long standing symptoms of post-nasal drip and nasal congestion, patience and compliance with treatment is very important. Although you may start feeling better within a few days, please stick to your treatments as long as your doctor suggests.

4. Non-pharmacological measures and precautions are as important as drugs in treatment of such chronic complaints, in my opinion. As suggested in previous answer, steam inhalation and nasal irrigation/rinsing regularly may be important for you on long term basis. Please consult your doctor for appropriate technique and also to know about other such simple measures that are important for you.

5. It will be ok to use decongestants like Afrin (oxymetazoline) nasal spray and Sudafed (pesudoephedrine) for occasional nasal congestion. But I would like to mention following cautions:

a. Both Afrin and Sudafed have same type of action, so you may be able to use any one of them at a time.

b. Decongestant nasal spray starts working rapidly but its use continuously for more than 3 days is mot recommended as there are chances of rebound congestion upon stopping its use.

c. Oral decongestant (like Sudafed) can cause side effects like insomnia (lack of sleep), increased heart rate, increased blood pressure, headache, etc. So please monitor yourself for such side effects.

Hope above suggestions will be helpful to you.

Should you have any other query, please feel free to ask on follow-up.

May God bless you the best of the health.

Thank you & Regards,

Dr. Parin N. Parmar

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