Hi,

Thank you for your query.

1. To understand the type of chronic rhinitis, in what percentage of total symptoms would you rate rhinorrhea (nasal discharge), sneezing and congestion? Are there any itching or eye symptoms? Are your symptoms present throughout the year or do they vary by season? Is there any specific trigger?

2. Your chronic post nasal drip must signify a stagnation and thickening of nasal secretions or an excess production due to some chronic irritation or inflammatory process, usually due to hypertrophied turbinates and also some problem in the sinuses. The source of the mucus is the nasal cavity and sinuses, which have a large XXXXXXX surface area and can produce a large amount of mucus. It probably accumulates during the night and drains in the morning.

3. I am assuming that true allergy has been ruled out by skin and blood tests. Get an AEC (Absolute Eosinophil Count) done. Get your nasal secretions checked for increased eosinophils. Do you have any symptoms of acid reflux?

4. Rule out hormonal imbalance, check for sub-clinical hypothyroidism. Rule out any exposure to chemicals, irritant fumes, household cleaning agents. Any relation of your symptoms to eating and drinking?

5. Intrinsic or Vasomotor Rhintis and Allergic Fungal Rhinosinusitis (AFRS) may be responsible for your chronic rhinitis. Have you had a nasal endoscopy and if yes, what were the exact clinical findings? The color and appearance of the nasal lining (mucosa) gives a fairly accurate idea of the type of rhinitis. For example, in allergy it is reddish purple, in vasomotor rhinitis it is red and in long standing allergy, it is pale white. Bogginess indicates an active inflammatory process. Discuss this with your physicians.

7. I would also recommend the following:
a. You should try and collect this fluid in a sterile container if it happens again and get it examined to rule out CSF (Cerebro Spinal Fluid). Get a Beta-2 Transferrin test on the fluid, if available.
b. Does the discharge increase in any particular position? ('teapot' sign or 'reservoir sign', where this fluid drips out on bending forwards or looking down).
c. 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.
d. If CSF leak is suspected, a CT cisternography and MRI with contrast should be done.

8. What specific medications are you currently on. I would use an anti histamine, an anti leukotriene, a steroid nasal spray (not a decongestant, which cause rhinitis medicmentosa), mucolytics and steam inhalation for at least two weeks and then reassess.

Hope I have answered your query. You may need to fill in some information. If you have any follow up queries I will be available to answer them.

Regards.

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Hi,

Thank you for writing back.

1. Your current may also be responsible, especially Lipitor (Atorvastatin). The only way to check is to replace the medication.

2. You should take a two week trial with an anti histamine, an anti leukotriene, a steroid nasal spray, mucolytics and steam inhalation. It takes about a week to ten days for the full effect to show.

3. Kindly let me know the results of your investigations and your response to the medication. This will help decide further treatment.

Hope I have answered your query. If you have any follow up queries I will be available to answer them.

Regards.

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