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Have extremely severe right sided rhinorrhea and spasmodic sinus pain. What is the treatment option?

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I have extremely severe right sided rhinorrhea and spasmodic sinus pain which occurs immediately after vigorous cardiovascular exercise, and persists for 24-36 hours afterwards. The drainage is completely clear, watery to thin mucous, and profuse to the point of being completely disruptive to normal activity. I have tried antihistamines, corticosteroids, and nasal ipatropium bromide with only minimal improvement. What are additional treatment options?
Posted Sat, 13 Oct 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 2 hours later

Thank you for your query.

1. You should get the fluid collected in a sterile container and get it tested to rule out a CSF (Cerebro Spinal Fluid) leak. Get a Beta-2 Transferrin test on the fluid, if available.

2. A simple test is the 'Handerchief Test': Normal nasal secretions contain mucus which will stain and stiffen a soft handkerchief on drying, but CSF will not.

3. Since your rhinorrhea is one sided, get a CT PNS (Para Nasal Sinuses). done. If a CSF leak is suspected, a CT cisternography and MRI with contrast should be done. Spontaneous leaks may be multiple. Rarely, a low pressure CSF leak is linked with neuronal migration disorders.

4. If you confirm that the fluid is not CSF then another possibility is a drug induced reaction or a drug interaction along with the normal effects of strenuous exercise.

5. Adderall is a vaso-constrictor and hence a nasal decongestant. Vigorous exercise also decongests the nasal and sinus mucosa (inner lining). You should review your medication as Adderall and Celexa (Citalopram) are not recommended together. Sometimes the nasal effects are due to the alteration of the Autonomous Nervous System by your current medications.

6. You may follow up with the answers to the above questions, results of the above investigations and treatment for further recommendations.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

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