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How is vasomotor rhinitis treated ?

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Practicing since : 1991
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I am 30 years old and have been bulimic for the past 10 years. I ended up having a permanent stuffy nose with a very low olfactory sense, which is still lingering even though I have not purged for a month now. Is there anything I can do in order to improve my condition?
Thank you!
Posted Sun, 6 May 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 29 minutes later

Thank you for your query.

1. Your nasal congestion and decreased olfactory sense may be related to the intense emotional response during purging or due to acid reflux.

2. The nose is supplied by as many nerves (including the autonomous nervous system) as the abundant blood vessels. Hence intrinsic or vasomotor rhinitis may develop after bulimia sets in.

3. Acid reflux is now proven to affect the sinuses and the even the ears. LPR (Laryngo Pharyngeal Reflux) is now a proven entity. Acid reflux also damages the ciliary system of the nose and sinuses, causing stasis of secretions and recurrent sinus infections. Do you also have damage to your teeth? Chronic dental infection can also affect the maxillary sinuses.

4. Get a detailed nasal examination, endoscopy (they help differentiate between the various types of rhinitis) and a plain CT PNS (Para Nasal Sinuses) to diagnose the nasal congestion. Medication will involve a trial with steroid nasal sprays, anti- allergics, steam inhalation which may also reduce your olfactory problem. If your sense of smell has reduced because nasal congestion obstructs airflow to the upper nose (where the olfactory area is situated), then it will recover completely after the treatment of nasal congestion. Do you use any decongestants? I usually ask for a pre and post decongestion CT PNS Scan.

5. If sinusitis or turbinate hypertrophy is proven on your scans, these can be successfully treated with endoscopic surgery or radio frequency ablation. A decade long acid reflux related mucosal damage may not be completely reversible.

6. Decrease in the sense of smell also decreases the flavor of food. It is encouraging to note that you have not purged for a month. Some recovery may occur on it's own now.

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

Above answer was peer-reviewed by
Follow-up: How is vasomotor rhinitis treated ? 3 days later
Thank you so much for your response and encouraging thoughts!
I will go for a nasal examination soon then.
I have not used any decongestants so far.
Yes, I have teeth damage, as well, but I am not as much concerned about them...

However, if you don't mind, I would like to ask for your opinion regarding my chronic fatigue: is that also a symptom derived from my eating disorder? I seem to go through periods when I feel exhausted to the point of dizziness without being able to figure out exactly why. My tests show that I have done some damage to my liver; would that be the cause of my state of extreme fatigue?
Is there anything you recommend me to do in order to help my recovery (if possible)?

Thank you! XXXXXXX
Answered by Dr. Sumit Bhatti 6 hours later

Thank you for writing back.

1. Both your liver damage and chronic fatigue syndrome are likely to be a consequence of purging, which leads to various nurtrient deficiencies. However, the liver and the body has a tremendous capacity to repair and regenerate itself if you allow it to do so.

2. Get your metabolic blood profile (Calcium, Phosphorus, serum electrolytes, renal and liver function tests, CPK, LDH, PTH, uric acid, alkaline phosphatase, hemogram, Vitamin B12 and routine urine) and thyroid function tests done.

3. A good diet fortified with vitamins and minerals will speed up your recovery.

Wishing you good health. You may follow up if any reports are outside normal limits.

Above answer was peer-reviewed by
Follow-up: How is vasomotor rhinitis treated ? 26 days later
Dear Dr. Bhatti,

First of all I went for a nasal examination and I've been diagnosed with vasomotor rhinitis and my nasal cornets show to be greatly enlarged. I have been prescribed a 10 days treatment with Aerius and Medrol tablets along with Awamys nasal sprey; however, my olfactory sense remained the same after the treatment. I've been suggested a surgery to shrink the nasal cornets, which would solve the nasal congestion and maybe help with the olfactory sense, as well, but for now I have decided to continue with the nasal sprey for a while and see what happens, since I don't have the money for such surgical intervention.

According to the rest of the testing I had done, the biggest problem appears to be my bone density situation, my overall T-score being -2.4, condition diagnosed as osteopenia. I've been told that two of my spine vertebras have osteoporosis values. My blood tests show that my Seric Calcium is in normal limits (9.518 mg/dL), but the 25-hidroxi vitamin D is low (26,6 ug/l). Do you think a vitamin D supplementation is necessary? What kind and dosage would you recommend?
Also my iron values are low (3.155 umol/L), and Seric Phosphorul high (1.605 mmol/L); the rest of my values seems to be normal. Could be the low level of iron the reason of my low energy level?

There is also another aspect I am concerned about and which would like to mention to you: it occurred to me a couple of times in the past few years to experience chest pain (I would not call them severe, but annoying enough through the fact that I would be so much aware of the existence of my heart during this time...)
The first time I got alarmed was two years ago when the pain (felt as pressure or squeezing) lasted several days and it happened after a violin audition I had around those days. After its disappearance I forgot about it for months and has returned here and there usually under stressful conditions accompanied by shortness of breath (especially when I am under severe time pressure) or when I overeat.
A couple of days ago I felt chest pain again- I think because of emotional distress- and lasted two or three days but at a low intensity. I must say that I have never had any heart issues when working out or under any physical activity.
I did some researched about chest pain, but can not tell if I should be really concerned about my sporadic chest discomfort or not?
I was thinking to ask about your advise because I am not in the financial state as to afford too many additional investigations...
I mentioned to you before that I am generally mostly annoyed and concerned by my frequent state of fatigue and dizziness; could this be connected to some sort of heart malfunction even though I don't experience often chest pain? Or could it be only my iron deficiency the reason of my exhaustion? (my liver seems to be okay, but my blood pressure is on the low side; also I notice that my pulse is quite faint since I only feel it around my neck and wrist)
What would you suggest me to do?
I have not purged for two months now and hopefully will never do it again...

Thank you so much for your useful advice; I greatly appreciate your help!

Answered by Dr. Sumit Bhatti 6 hours later

Thank you for writing back.

1. For your vasomotor rhinitis, request your physician to add a leukotriene antagonist such as montelukast or zileuton. In addition you must do alkaline or saline nasal douching. You should continue with the steroid nasal spray for a few months. You may taper it later. If your relief is not satisfactory, or if olfaction is still poor, then Radio-Frequency ablation is recommended. It is a fairly simple procedure and probably overcharged in most parts of the world. I do this procedure at a nominal cost for patients who cannot afford, though the ones who can are billed for all the disposables and the Radio-Frequency Generator.

2. Yes, you should have Vitamin D supplementation. This is best taken as Cholecalciferol (Calcitriol), which is easy for the body to absorb and process. Cholecalciferol is available as 1 gm sachets containing 60,000 IU. You should also have Calcium, for example in combination with Vitamin D such as calcitriol 0.25 mcg with calcium carbonate 500 mg. Your raised levels of phosphorus are related to your osteoporosis.

3. Iron supplementation is important. If you correct your low iron most of your problems will disappear. Newer iron formulations are easy to tolerate. Include iron XXXXXXX food in your diet.

4. Your sporadic chest pain may be due to Tietze Syndrome which may be related to the above deficiencies. At your age, and with your intermittent history, heart disease is unlikely. You should investigate further only if your symptoms worsen or persist despite this treatment.

5. Have a good vitamin supplement such as Centrum Silver 50+ for two to three months. Your low energy levels and chronic fatigue will disappear.

Wishing you a speedy recovery.

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