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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Suggest treatment for severe nasal congestion caused by vasomotor rhinitis

Answered by
Dr.
Dr. Sumit Bhatti

ENT Specialist

Practicing since :1991

Answered : 2588 Questions

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Posted on Tue, 20 Sep 2016 in Ear, Nose and Throat Problems
Question: I have been having nasal congestion for a little over month now that came on suddenly. When I say congested, I do not mean with mucous, I mean just the passages are swollen ( turbinates). Not sure what has brought this on. We are in the process of selling our home and did have a few things done around the house ( my husband stained a small area of wood, had a small area of drywall replaced on our back porch( I was not in direct contact though and it was outside), had our laundry room tiles replaced( this room is not in our house, it is downstairs and separate from the house, and also a lot of cleaning. The day the nasal irritation/stuffiness started I had a crying spell right beforehand. I had hurt my lower back a couple weeks prior( pulled a muscle) and was finally healing when I tripped and pulled that muscle again and it hurt so bad I laid down and cried for a few minutes( out of pain and frustration). Well my nose got runny and stuffy right after I cried which is normal and it always goes away in a few minutes. Well after a half an hour my back was feeling better again so I went downstairs to the basement apartment and started cleaning and sweeping a little. Went out to the store afterwards and noticed my nasal passages were feeling irritated and kind of stuffy. Well when I got home my husband had just cleaned a big area rug we had with resolve carpet cleaner. It smelled very fragrant so I stayed out of that room, but you could still smell it. Finally the next day I had him toss it out because my nose was still feeling irritated and stuffy so I thought that would just make it worse with keeping the rug in the house. I noticed the morning after this started I sneezed and the left side of my nasal passages was runny and irritated for about a half and hour then that stopped so it did not seem like a cold or anything. Well my nose has been consistently inflamed and stuffy since. I went to see an ENT doctor and he said I was congested( swollen). He did a CT scan since I was having some slight pressure around my eyes and in and around my nasal area.The CT was normal meaning no build up in my sinuses. He just said my nasal turbinates were swollen. He told me to use Nasonex spray. I tried it for a day but felt it kind of irritated me further, making me more stuffy on the side I used it on so I did not continue it. He then gave me medrol dose pack( 4mg pills ) that I take 6 the first day, 5 the second day, 4 the third day until I am done on 6th day. I felt maybe it helped a little the first day but then was still stuffy and not feeling the greatest still. I went to see my allergist then and she said she did not believe this was allergies because she said I would have a runny nose, watery itchy eyes. My only symptom is stuffy irritated dry feeling nasal passage and occasional pressure around the eyes. I sneeze, but only once or twice a day. The nasal stuffiness is my main symptom though. She said to try nasacort nasal spray. I have been using it for a week now and if it is helping it is only Very minimal. The only thing that seems to help some if if I take oral 30mg Pseudophedrine. I only take it every couple days( only once a day) when I just cannot handle it. I do not want to take it all the time due to all the side effects it can cause. My allergist said it was fine to take as needed since I do not have high blood pressure( I actually tend to be lower). I also tried neti-pot using distilled salt water and baking soda and it felt like it irritated me more. I am at a loss as to what to do next.

What could be doing this and why is nothing helping? ENT doc mentioned I have a slight deviation in my septum but due to how this just came about suddenly he did not feel that was even contributing to this. What are your thoughts on this, and what can I do to get my nasal passages to stop swelling? The only thing I can think of was that I cried when I was laying down when I pulled my back and then all this started. Granted we were cleaning some in the house too and that may have contributed too, I just do not know but shouldn't this has went away by now? Any suggestions? Oh, I was on zyrtec for 5 years for skin itching I would get(I am sensitive to things and will get odd rashes or itchiness from medications or just out of nowhere so my allergist told me to take the zyrtec a few years back), a low dose only 5mg a day. When this all started I was on the 5mg of zyrtec so I figured it could not be an allergy as the zyrtec would have helped or even prevented it. I since have stopped the zyrtec 2 weeks ago just to see if maybe it was causing my nasal passages to be more dry and causing this but I am still the same, no change. Any suggestions or ideas of what could be happening here??
doctor
Answered by Dr. Sumit Bhatti 3 hours later
Brief Answer:
Intrinsic / Vasomotor Rhinitis, Rule out NARES.

Detailed Answer:
Hi,

Thank you for your query.

1. This history and symptoms suggest the possibility of Intrinsic / Vasomotor Rhinitis. NARES (Non Allergic Rhinitis with Eosinophila Syndrome) should be ruled out.

2. The exposure to odors, fumes, the stress of the muscle injury, shifting to a new home, any medication for this injury (drug induced by anti-inflammatory medication or rebound from decongestants) are causes of Intrinsic / Vasomotor Rhinitis.

3. There may be a component of dust allergy (Mixed Rhinitis). Hormonal changes due to stress may also contribute.

4. Nasal steroids, nebulization are usually helpful. If not, you can start with a combination of an anti-histamine and an anti-leukotriene. Most patients will respond to medical treatment. A few need nasal turbinate reduction by radiofrequency, coblation or other surgical techniques.

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. Arnab Banerjee
doctor
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Follow up: Dr. Sumit Bhatti 32 minutes later
Thank you for your reply. I have not taken any kind of NSAIDS as I cannot tolerate those. I also have not used any nasal spray decongestants except for the Nasal Steroid one ( nasacort) which I don't think is a decongestant It is not helping too much anyways and I have been on it for a week now.

I have had this for just little over a month now and it started out of the blue, like all of a sudden. Would you think this is too early for surgery? also, when is this considered Chronic? When researching on the Internet, I have come across some sites that state if swelling and congestion of the turbinates do not get better then it will be permanent. This is scary. How long does it take for it to be considered " long term" to where the trubinates are permanently damaged to where they wont shrink on their own again? I asked my primary care doctor about this and she said it is not true and it would take years for it do this. What is your opinion on this?

If this was caused by breathing in dust/or mold spores from when cleaning( though I never saw any kind of mold but have read you can have mold hidden in places to where it will release spores and toxins and it can affect people who are sensitive to it) wouldn't this have passed by now since we are not doing any work in the house anymore?

Lastly, can stress cause this? If so, how do I remedy it or what could I take to help with this?
doctor
Answered by Dr. Sumit Bhatti 6 hours later
Brief Answer:
Details as discussed below:

Detailed Answer:
Hi,

Thank you for writing back.

1. NSAIDs are one of the many causes for Vasomotor/ Intrinsic / Non Allergic Rhinitis.

2. Nasal steroids require 5 to 7 days of regular use to reach effective action.

3. Pseudoephedrine is a decongestant with a rebound action even if taken every alternate day.

4. Vasomotor / Intrinsic / Non-allergic Rhinitis can appear suddenly.

5. Nasal turbinate hypertrophy can be considered chronic if there is no relief after 6 to 8 weeks of treatment.

6. This is very common and most cases respond to medical treatment. A few need nasal turbinate reduction by radiofrequency, coblation or other surgical techniques.

7. The stress of the earlier situation may have precipitated this. Part was from the injury. There can be added mold and dust allergy (Mixed Rhinitis).

8. The nasal washes should be with hypertonic saline (2%) and not with distilled water.

9. Get an ENT Consultation from a specialist who has experience in handling these conditions. You will get relief.

10. If this is not possible, request a pre and post decongestion plain Sinus CT. After the first Sinus CT, use 5-8 drops of Otrivin (0.1% Xylometazoline) nasal drops on both sides. Repeat the Sinus CT after 15 minutes. Compare the images with any change in the nasal obstruction. The radiologist has to reduce the scanner settings to halve the radiation dose. Upload the images 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. Priyanka G Raj
doctor
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Follow up: Dr. Sumit Bhatti 15 hours later
Thank you for the reply. I am confused. I was told by the ENT doctor I saw that oral pseudophedrine was safe and did not cause rebound congestion. He said Only the nasal spray decongestants like Afrin cause rebound congestion issues. So far I have had this for almost 5 weeks and nothing seems to be helping really except for when I occasionally take the oral Sudafed, it helps some. In your opinion could this be an infection of some sort( bacterial or fungal) even in the absence of green mucous drainage? I hardly have any drainage at all really. My nasal passages feel more dry and irritated with stuffiness. It is my understanding that the treatments like Nasal steroid sprays, antihistamines etc.. only work for Allergic Rhinitis. What are the treatments for Non allergic/Vasomotor rhinitis?

doctor
Answered by Dr. Sumit Bhatti 26 hours later
Brief Answer:
Rhinitis Medicamentosa.

Detailed Answer:
Hi,

Thank you for writing back.

1. Pseudoephedrine causes rebound congestion. The condition is known as Rhinitis Medicamentosa.

2. This is unlikely to be an infection, but it can be an allergic reaction to a fungus.

3. Treatment of Non allergic rhinitis is similar. It includes anti histamine nasal sprays (such as azelastine) and steroid nasal sprays, saline nasal washes and oral decongestants (such as pseudoephedrine, which explains the improvement). Besides these, there are surgical treatments as mentioned earlier.

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
doctor
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