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Suggest treatment for chronic rhinosinusitis

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Posted on Tue, 28 Mar 2017
Question: I've had this draining since 2010 thought and was checked out for sinus problems now it doesn't drain with sinus but where ever it can go ,it moves from bach of head over and down the side of my face its nunb when it drains mostly nitice when laying down , ca't sleep with this movement going on ,so done sleep , now it closes in around my tehroat on outside and drains down my neck settleing in where ever ,I feel it draining clear down along side of stomach ,my legs and feet are swelled just about all the time till they ache , been every where test after test ,jumping thru hoopa but nobody knows what this is ,had all test heart good lungs clear , can't breath very good very short breath it feels like my whole insides is squeezing everything flem is clear supper thick at time , sometime a tiny spot of blood in mucus it just hangs in throat like a ballon with just a little of water in it hanging won't go out or down looking for help thank you,went to FL< last XXXXXXX and soon as I got their was when I got short winded, been ever since been on inhalers nose sprays , even had devaited suptrum operation nothing helped
doctor
Answered by Dr. Lekshmi Rita Venugopal (3 hours later)
Brief Answer:
Diagnosis: Chronic Rhinosinusitis Advice to consult an immunologist

Detailed Answer:
Hello,
Thank you for your query at HealthcareMagic,

I have gone through your history and understand your concern. The symptoms you are describing are probably due to Chronic sinusitis associated with allergic rhinitis.

I see that there are certain known allergens triggering your symptoms. Avoid exposure to already known allergens. But it is equally important to look for any new/other allergens causing your symptoms. I'd recommend that you undergo allergy testing to look for potential allergens.

Chronic rhinosinusitis is treated with saline nasal spray, nasal decongestant (not preferred for long term use), anti histamines, steroid nasal spray, immune modulators and most importantly- avoiding exposure to allergens.

Meanwhile, here are few things to help control your symptoms--

- Avoid exposure to already known allergens
- use saline nasal spray and saline nasal wash
- over the counter antihistamine like cetirizine (10mg once daily at bed time)
- steam inhalation twice daily
- avoid long term use of over the counter nasal decongestants,as it can cause problems to nasal mucosa
- Tylenol (if not allergic) for pain

The pain and swelling of the feet may be due to the medication lyrica or preipheral vascular disease.I recommend that you regularly take cilostazol and exercise regularly like walking for at least 30 minutes and follow up with your treating physician.

CONSULT AN IMMUNOLOGIST/ALLERGY SPECIALIST to get allergy testing, further evaluation and appropriate management.

Hope I was able to answer your question
Please feel free to address any more concerns and questions.
Regards,
Dr.Lekshmi

Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Lekshmi Rita Venugopal (14 hours later)
Sorry I have done all this ,and use all of these thing ,I have a allergyist i get shot every other week was every week for 8 years hr doese regular rechecks ever so often I'm on be shots I've been to the Mail clinic on this as well as the U of M hospital in XXXXXXX Arbor Mi. So tell me something different Its not sinus it runs along side of sinus it starts draining from the back of head , this morning at !15 am it woke me up ,thick stuff was draining down my throat ,really thick then it all started draining off ,my whole body has been swelled for a long time i could feel it leting go clear down to my toes all the way up my legs my butt my back belly on up what a feeling to be able to bend your knee ,move your toes just to feel it pulling away from my heart and lungs ,their not so confined my neck its all opened ,but still have fresh draining comming from the back of my head at the neck, so your the first to hear its not all out may never but I feel so much better even to have a little drain off thank you
doctor
Answered by Dr. Lekshmi Rita Venugopal (2 hours later)
Brief Answer:
Diagnosis:Post Nasal drip, possibility of swollowing problems/GERD

Detailed Answer:
Hello,
Thank you for following up.

The symptoms you are describing of secretions going down the back of head towards the throat is post nasal drip.Post nasal drip occurs generally due to increased secretions from nose and sinuses dripping back to throat.It is commonly seen in chronic allergic rhinosinusitis.

But since you have been on long term management for allergies and the symptoms are still persistant other possibilities like swollowing difficulties and Gastro Esophageal reflux disease(GERD,it is a condition where gastric acid reflux back into Esophagus) should be considered. Both swollowing difficulties and GERD can present with increased secretions in the throat and is usually more symptomatic while sleeping or at night.

GERD is treated with medications to decrease stomach acid like pantoprazole and swollowing difficulties are treated depending on it's cause.
There are few things you can try to belp relieve GERD
-Avoid spicy fatty fried food
-Avoid coffee,chocolate,carbonated drinks
-raise the head side of bed by using blocks underneath bed posts
-never go to bed/sleep immediately after eating.Give atleast 3 hours between meal and bed time.

Mean while I advice that you continue the appropriate management for allergies.
I also recommend that you consult your Primary care provider for evaluation of swollowing problems/GERD and management accordingly.

Hope I was able to help you.
Please feel free to address any more concerns.
If you do not havd further clarifications, please close and,rate this discussion.
Wishing you good health
Dr.Lekshmi

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Lekshmi Rita Venugopal (24 minutes later)
With the gerds I do have some acid reflex and had the test with the camera , I'm on med called pantoprazole 40mg now so you see I have all the bases covered , you should check ,i have this drainaged other then sinus draining in my throat , I don't think its post nasel drip ,for none of the specialists I've seen a
has brought it up , I do beleive its call spread the money around and keep haveing me jump thru hoops , about to give up and just deal with it , but I'm sure their is other people out their that has this ,nobody knows , I even had doctor say its a old ladys drip ,hello I don't feel old and I won't let this keep me from doing what I want to do
doctor
Answered by Dr. Lekshmi Rita Venugopal (4 hours later)
Brief Answer:
Post Nasal drip,advice videofluroscopic barium swallow

Detailed Answer:
Hello,
I have gone through your question and I understand your concern.

Your symptoms are due to excessive secretions in throat,The cause of which has to be looked for.
Since you have undergone extensive investigations,The only thing that need to looked for at this point is presence of swallowing difficulties in particular with the muscles of mastication(muscles for chewing and swallowing)
Certain neurological problems like parkinson's can present with similar complaints in very early stages without any other obvious symptoms.
You will need to undergo a test called videofluroscopic barium swallow to look for the problems with muscles of mastication.
I recommend that you consult your primary care physician who can refer you to a Gastrointestinal specialist for further evaluation.

Hope I was able to help you.
Please feel free to address any more concerns.
If you do not have further clarifications, please close and,rate this discussion.
Wishing you good health
Dr.Lekshmi

Above answer was peer-reviewed by : Dr. Prasad
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Answered by
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Dr. Lekshmi Rita Venugopal

General & Family Physician

Practicing since :2012

Answered : 3614 Questions

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Suggest treatment for chronic rhinosinusitis

Brief Answer: Diagnosis: Chronic Rhinosinusitis Advice to consult an immunologist Detailed Answer: Hello, Thank you for your query at HealthcareMagic, I have gone through your history and understand your concern. The symptoms you are describing are probably due to Chronic sinusitis associated with allergic rhinitis. I see that there are certain known allergens triggering your symptoms. Avoid exposure to already known allergens. But it is equally important to look for any new/other allergens causing your symptoms. I'd recommend that you undergo allergy testing to look for potential allergens. Chronic rhinosinusitis is treated with saline nasal spray, nasal decongestant (not preferred for long term use), anti histamines, steroid nasal spray, immune modulators and most importantly- avoiding exposure to allergens. Meanwhile, here are few things to help control your symptoms-- - Avoid exposure to already known allergens - use saline nasal spray and saline nasal wash - over the counter antihistamine like cetirizine (10mg once daily at bed time) - steam inhalation twice daily - avoid long term use of over the counter nasal decongestants,as it can cause problems to nasal mucosa - Tylenol (if not allergic) for pain The pain and swelling of the feet may be due to the medication lyrica or preipheral vascular disease.I recommend that you regularly take cilostazol and exercise regularly like walking for at least 30 minutes and follow up with your treating physician. CONSULT AN IMMUNOLOGIST/ALLERGY SPECIALIST to get allergy testing, further evaluation and appropriate management. Hope I was able to answer your question Please feel free to address any more concerns and questions. Regards, Dr.Lekshmi