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Dr. Andrew Rynne

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Overweight with mild arthritis. Feeling lightheaded, congestion and have bloody nose. What to do?

Answered by
Dr. Ravinder Sharma

ENT Specialist

Practicing since :1992

Answered : 332 Questions

Posted on Sat, 9 Feb 2013 in General Health
Question: I am a 50 year old woman who is overweight with mild arthritis, but otherwise healthy.
About 3 months ago, I started getting bloody noses and congested feelings in my sinuses. Blowing will stop the bleeds in a few minutes when I clear my sinuses. Crusts constantly develop in my nose and, when I clear them, they are often attached to veins. Lying down, the fullness in my sinuses will shift with gravity.
In the mornings I will feel light-headed when I first get up from the congestion.
A couple of weeks ago I got a cold on top of the other sinus condition and my internist gave my antibiotics assuming it was acute sinusitis, I finished the antibiotic and the cold symptoms have gone, but I still have the original bloody noses and sinus congestion.
Lastly, when I was about 10 years old, I had a procedure to my nose which an ENT performed in his office to stop my bloody noses. I was given anesthesia and he cleared out my sinuses. My mom does not remember what the diagnosis.
I am guessing that the bleeds are caused by polyps. What to do?
Answered by Dr. Ravinder Sharma 11 hours later
I am Dr Ravinder Sharma ENT surgeon
On the basis of the information provided it appears to be due to atrophic changes in nasal mucous glands leading to crusting and wehn these crusts are removed it leads to bleeding. At times it gets secondarily infected. It do not appears to be because of polyps. I would advise you doe a ENT consultation , Ct scan Paranasal sinuses , nasal endoscopy and can start liquid parrafin nose drops 2 drops two to three times a day.

I hope this answers yur concern. Feel free to contact me if you require more information about it

with regards
Ravinder Sharma
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ravinder Sharma 29 hours later
Please be more specific about your diagnosis and the reasoning behind it. I have searched "atrophic changes in nasal mucous glands" and came up with the following:

Atrophic rhinitisA chronic inflammation of nose characterised by atrophy of nasal mucosa including the glands, turbinate bones, and the nerve elements supplying the nose.
Allergic rhinitisRhinitis associated with hay fever.
Common coldViral infectious disease of the upper respiratory system, caused primarily by rhinoviruses and coronaviruses. common symptoms include a sore throat, runny nose, and fever. ...
Vasomotor rhinitisCongestion of nasal mucosa without infection or allergy.
SinusitisInflammation of a nasal sinus

None of the symptoms appear for any but sinusitis or polyps. Why did you dismiss polyps as a possible cause?

I would be happy to give more information about my symptoms to assist a more detailed explanation.

Thank you.
Answered by Dr. Ravinder Sharma 1 hour later
Thanks for your follow up query

Crusting associated with blood stained discharge is not a common feature of nasal polyp or allergic rhinitis

Allergic rhinitis is associated with rhinorrhoea, sneezing and nsal obstruction. It may lead to formation of nasal polyp. Bloody discharge is not a feature of nasal polyp. Rarely there may be blood stained discharge in allergic rhinitis but it is not a regular feature.

Sinusitis may be associated with allergic rhinitis or atrophic rhinitis

I am trying to help you out on the basis of clinical information provided. This is not an alternative of the clinical examination and investigations. I would be happy to help you further if you provide me the CT scan and nasal endoscopy images. Medicine has no reules and there may be unusual presentations. But I have concluded on the basis of your complaints and this appears to be the most probable cause. I have not dismissed nasal polyp as a cause of these symptoms I have quoted that it appears to be less likely cause.

I hope this answers your concern. Feel free to contact me if you require more clarification about it.

with regards
Ravinder Sharma

Please provide your his
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ravinder Sharma 6 hours later
Would you please give me a medical definition of atrophic rhinitis?

What are the risk factors of not following-up with an ENT? Although annoying, the problem does not seem to affect my overall health, aside from the congestion and some loss of smell.

Thank you, Dr. Sharma!
Answered by Dr. Ravinder Sharma 13 hours later
Thanks for the follow up query

Atrophic rhinitis is defined as the atrophy of the glands in nasal mucosa and turbinates. As a result there is shrinkage of the walls of nasal cavity leading to roomy nose. As the patient breathes in, there are chances of crusting in nose which may get secondarily infected and can cause foul smell from nose. Attempting removal of crust may cause nose bleeding

Clinical features include

1. History of crusting and blood stained discharge , anosmia and depressed nasal bridge (in later stage)
2. Examination shows roomy nose, lack of olfaction, crusts in nose
3. Sinus X XXXXXXX may show features suggestive of sinusitis

It can be because of the variety of causes
1. Nutritional deficiency - Vitamin A , D or iron deficiency
2. Infective cause - Klebsiella ozaenae, Diptheroids,Proteus vulgaris and E coli, syphilis
3. Hereditary factors - Some patients have a positive family history
4. Endocrinal disturbance
5. Deviated nasal septum
6. Arise de novo - when on work up no cause is found . Also called as Primary atrophic rhinitis

The diagnosis is usually based on examination. It requires a course of antibiotics to treat infection and patient is advised to keep to nose moist with liquid parrafin nose drops. If untreated it may lead to saddle nose (depressed nasal septum) due to absorption of cartilage in nasal septum. If untreated for long term one may require surgery.

I have provided some literature to tell you about this disease but it does not mean that you are suffering form this disease. I would further advise you to please consult a ENT surgeon first before thinking of the diagnosis.

I hope this answers your concern. Feel free to contact me if you require more information about it

with regards
Ravinder Sharma

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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