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What is the remedy for chronic rhinitis post surgical removal of wisdom teeth ?

i have had chronic rhinitis for the past year. it all started when i had my wisdom teeth surgically removed. the two bottom ones abcessed and i was sick for well over a month. after that i got a sinus infection. it was stubborn and i was prescribed about 6 courses of antibiotics of.all different kinds, none of which helped. i was then prescribed steroidal nasal spray . took twice a day for 5 months to no effect. by this point i was having almost no nasal discharge whatsoever and was mainly swollen to the point of not being able to breathe . i went to an ENT and had a camera up my nose and he found nothing and suggested nothing. he did however rule out allergies. in the last few days it has become unbearable. im beginning to physically feel sick, achey, lethargic and i am extremely tierd from lack of sleep. other symtoms include bad taste, stinging throat, watery eyes at night, head aches between eyes. please help.
Asked On : Sun, 15 Apr 2012
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General & Family Physician 's  Response
Hello and welcome to

Nonallergic rhinitis occurs when blood vessels in your nose expand (dilate), filling the nasal lining with blood and fluid. There are several possible causes of this abnormal expansion of the blood vessels or inflammation in the nose. But, whatever the trigger, the result is the same — swollen nasal membranes and congestion.

Nonallergic rhinitis triggers include:
1) Environmental or occupational irritants. Dust, smog, secondhand smoke or strong odors, such as perfumes, can trigger nonallergic rhinitis. Chemical fumes, such as those you might be exposed to in certain occupations, also may be to blame.
2) Weather changes. Temperature or humidity changes can trigger the membranes inside your nose to swell and cause a runny or stuffy nose.
3) Infections. A common cause of nonallergic rhinitis is a viral infection — a cold or the flu, for example. This type of nonallergic rhinitis usually clears up after a few weeks but can cause lingering mucus in the throat (postnasal drip). Sometimes, this type of rhinitis can become chronic, causing ongoing discolored nasal discharge, facial pain and pressure (sinusitis).
4) Foods and beverages. Nonallergic rhinitis may occur when you eat, especially when eating hot or spicy foods. Drinking alcoholic beverages, such as beer and wine, also may cause the membranes inside your nose to swell, leading to nasal congestion.
5) Certain medications. Some medications can cause nonallergic rhinitis. These include nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin, others), and high blood pressure (hypertension) medications, such as beta blockers. Nonallergic rhinitis can also be triggered in some people by sedatives, antidepressants, oral contraceptives or drugs used to treat erectile dysfunction. Overuse of decongestant nasal sprays can cause a type of nonallergic rhinitis called rhinitis medicamentosa.
6) Hormone changes. Changes in hormones due to pregnancy, menstruation, oral contraceptive use or a hormonal condition such as hypothyroidism can cause nonallergic rhinitis.
7) Stress. Emotional or physical stress can trigger nonallergic rhinitis in some people.

Some treatments include:
1) Saline nasal sprays. Use an over-the-counter nasal saline spray or homemade saltwater solution to flush the nose of irritants and help thin the mucus and soothe the membranes in your nose.
2) Corticosteroid nasal sprays. If your symptoms aren't easily controlled by decongestants or antihistamines, your doctor may suggest a prescription corticosteroid nasal spray, such as fluticasone (Flonase) or mometasone (Nasonex). Corticosteroid medications help prevent and treat inflammation associated with some types of nonallergic rhinitis. Possible side effects include indigestion, nausea, headache and bodily pains.
3) Antihistamine nasal sprays. Try a prescription antihistamine spray such as azelastine (Astelin) and olopatadine hydrochloride (Patanase). While oral antihistamines don't seem to help nonallergic rhinitis, antihistamine in the form of a nasal spray may reduce symptoms of nonallergic rhinitis. Side effects may include a bitter taste in your mouth, headache and fatigue.
4) Anti-drip anticholinergic nasal sprays. The prescription drug ipratropium (Atrovent) is often used as an asthma inhaler medication. But it's now available as a nasal spray and can be helpful if a runny, drippy nose is your main symptom. Side effects may include a bitter taste in your mouth and drying of the inside of your nose.
5) Oral decongestants. Available over-the-counter or by prescription, examples include pseudoephedrine-containing drugs (Actifed, Sudafed, others) and phenylephrine (Neo-Synephrine, others). These medications help narrow the blood vessels, reducing congestion in the nose. Possible side effects include high blood pressure, insomnia, loss of appetite, heart pounding (palpitations), anxiety and restlessness.
6) Decongestant nasal sprays. These include oxymetazoline (Afrin, others). DON'T USE THESE MEDICATIONS FOR MORE THAN THREE OR FOUR DAYS, as they can cause congestion to come back with even worse symptoms when you stop using them. Other possible side effects include headache, insomnia and feeling nervous.

Complications from nonallergic rhinitis include:
1) Nasal polyps. These are soft, noncancerous (benign) growths that develop on the lining of your nose or sinuses due to chronic inflammation. Small polyps may not cause problems, but larger ones can block the airflow through your nose, making it difficult to breathe.
2) Chronic sinusitis. Prolonged nasal congestion due to nonallergic rhinitis may increase your chances of developing sinusitis — an infection or inflammation of the membrane that lines the sinuses. When sinusitis lasts for longer than 12 consecutive weeks, it's referred to as chronic sinusitis. Sinusitis causes pain, tenderness and swelling around your eyes, cheeks, nose or forehead.

There are certain things that you can do for yourself to help reduce discomfort and relieve the symptoms of nonallergic rhinitis:
• Rinse your nasal passages. Use a specially designed squeeze bottle, such as the one included in saline kits (Sinus Rinse, others), bulb syringe or neti pot to rinse your nasal passages. This home remedy, called nasal lavage, can help to keep your nose free of irritants. When used daily, this is one of the most effective treatments for nonallergic rhinitis. Use water that's distilled, sterile, previously boiled and cooled, or filtered using a filter with an absolute pore size of 1 micron or smaller to make up the irrigation solution. Also be sure to rinse the irrigation device after each use with similarly distilled, sterile, previously boiled and cooled, or filtered water and leave open to air dry.
• Blow your nose. Regularly and gently blow your nose if mucus or irritants are present.
• Humidify. Set up a humidifier in your work or sleep location. Or breathe in the steam from a warm shower to help loosen the mucus in your nose and clear your head of stuffiness.
• Stay hydrated. Drink plenty of liquids, such as water, juice or noncaffeinated tea. Avoid caffeinated beverages, which can cause dehydration and aggravate your symptoms

Contact your family physician with your concerns and complications. Together devise a strategy to eliminate your disease process.

Be well,
Dr. Kimberly
Answered: Sun, 15 Apr 2012
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