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Suggest treatment for chronic nasal congestion

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Posted on Sun, 13 Nov 2016
Question: Hi

I have chronic nasal congestion. The ENT I visit confirmed that my turbinates/sinus are swollen but that is all. I would like to know if there is a way for the ENT to diagnose what is causing the swelling.
doctor
Answered by Dr. Sumit Bhatti (42 minutes later)
Brief Answer:
Yes, Nasal endoscopy and a plain CT PNS.

Detailed Answer:
Hi,

Thank you for your query.

1. Nasal endoscopy and a plain CT PNS (Para Nasal Sinuses) will help confirm nasal turbinate hypertrophy and sinusitis.

2. I recommend that you get a plain CT PNS done pre and post de-congestion with 0.1% Xylometazoline nasal decongestant drops. The procedure is as follows. After the first scan, use 5 to 8 drops of 0.1% Xylometazoline nasal decongestant drops in both sides of the nose. Wait 15 minutes and rescan. The radiation settings can be reduce by half. Print these images side by side and compare and co-relate with any subjective improvement of your nasal congestion.

3. Upload the endoscopy and scan images for either here or directly at bit.ly/Dr-Sumit-Bhatti

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

Regards.
Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar
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Follow up: Dr. Sumit Bhatti (12 hours later)
Are you saying a catscan can tell me what is causing my swollen sinuses?

I had a catscan that said I had Ethmoid disease. If I upload the report would you be able to give me your opinion on the likeliness the ethmoid disease is causing the swollen turbinates or is it the swollen turbinates causing Ethmoid disease?
doctor
Answered by Dr. Sumit Bhatti (9 hours later)
Brief Answer:
Details as discussed below:

Detailed Answer:
Hi,

Thank you for writing back.

1. Ethmoid sinusitis is commonly seen as a part of chronic sinusitis.

2. The cause and effect relationship can be either way.

3. After succesful treatment both the ethmoid sinusitis and the enlarged turbinates will settle down.

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

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sumit Bhatti (45 hours later)
Thank you for the information.

Below is the report from a CT scan I did.

I would like to know what steps I should take to solve my chronic stuffy nose problem based on the information.

what would you do if you were in my shoes?

I should also mention that I have allergies my whole life but its only recently I have been having these nasal problems.


"Exam: CT SCAN OF THE SINUSES (WITHOUT CONTRAST):
Clinical data: Evaluate for sinusitis.
Technique: Spiral CT scanning of the paranasal sinuses was perfonned. Coronal and axial images were
obtained. ยท The patient was imaged with bone and brain windows. Intravenous contrast was not utilized. Post
processing and multiplanar images were obtained and were reviewed.
Prior studies: No priot studies.


Findings:
MAXILLARY SINUSES: There is mucosal thickening involving the right and left maxillary antrum.
The osteomeatal units remain patent.
NASAL STRUCTURES: There is bilateral nasal turbinate hypertrophy. There is deviation of the middle nasal septum to the right and anterior cartilaginous septum to the left.
SPHENOID SINUSES: They are clear. Sphenoethmoidal recesses remain patent.
ETHMOID SINUSES: There is mucosal thickening involving the right and left middle ethmoidal air cells.
FRONTAL SINUSES: There is mucosal thickening involving the left frontoethmoidal recesses. Right frontal sinus is clear.

IMPRESSION:
I. BILATERAL NASAL TURBINATE HYPERTROPHY AND NASAL SEPTAL DEVIATION.
2. MUCOSAL THICKENING INVOLVING THE RIGHT AND LEFT MAXILLARY ANTRUM.
3. MUCOSAL THICKENING INVOLVING THE LEFT FRONTAL SINUS.
4. BILATERAL ETHMOID SINUS DISEASE."
doctor
Answered by Dr. Sumit Bhatti (15 hours later)
Brief Answer:
Details as discussed below:

Detailed Answer:
Hi,

Thank you for writing back.

1. It will be better if you can upload a few scan images.

2. Initial treatment should be with medication. This should include anti-allergic medication, steroid nasal sprays, steam inhalation and saline / hyper-tonic saline nasal washes.

3. Allergy tests can be done to determine the allergens involved.

4. If medication does not help, Radio-frequency or Coblation assisted nasal turbinate reduction is useful. Balloon Sinuplasty or Functional Endoscopic Sinus Surgery (FESS) is an additional option.

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

Regards.
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Sumit Bhatti (24 hours later)
Hi

thank you for the info and timely response.

I would like to know if it is common that turbinate reduction procedures would also open up my block sinus passages, as a by product of having smaller turbinates.

Similarly, I would like to know if it is common for Balloon Sinuplasty to clear up chronic congestion as well.

Or is it more likely that I would have to do both procedures to address both issues.

Also is there a way to confirm that allergies is causing my sinusitis and not something like a virus infection?

My mucus have been clear/white 90% of the time.
doctor
Answered by Dr. Sumit Bhatti (8 hours later)
Brief Answer:
Details as discussed below:

Detailed Answer:
Hi,

Thank you for writing back.

1. To some extent, turbinate reduction will help open up the sinuses.

2. Balloon Sinuplasty helps clear up chronic congestion.

3. Both these procedures together will be beneficial together. After nasal airflow improves (in about 4 to 6 weeks), further improvement is seen in the following months and years.

4. Virus infections do not last very long. Chronic sinusitis is more likely due to allergies and repeated infections.

5. The white clear mucus consists of sinus secretions and dead white blood cells. You can culture it for bacterial growth and sensitivity to antibiotics. Sometimes, there is fungus involved. The fungus may only be present in the sinus cavities (outside the body), yet cause a reaction.

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

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Sumit Bhatti

Otolaryngologist / ENT Specialist

Practicing since :1991

Answered : 2660 Questions

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Suggest treatment for chronic nasal congestion

Brief Answer: Yes, Nasal endoscopy and a plain CT PNS. Detailed Answer: Hi, Thank you for your query. 1. Nasal endoscopy and a plain CT PNS (Para Nasal Sinuses) will help confirm nasal turbinate hypertrophy and sinusitis. 2. I recommend that you get a plain CT PNS done pre and post de-congestion with 0.1% Xylometazoline nasal decongestant drops. The procedure is as follows. After the first scan, use 5 to 8 drops of 0.1% Xylometazoline nasal decongestant drops in both sides of the nose. Wait 15 minutes and rescan. The radiation settings can be reduce by half. Print these images side by side and compare and co-relate with any subjective improvement of your nasal congestion. 3. Upload the endoscopy and scan images for either here or directly at bit.ly/Dr-Sumit-Bhatti I hope that I have answered your query. If you have any further questions, I will be available to answer them. Regards.