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Suggest Treatment For Symptoms Of Vasomotor Rhinitis

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Posted on Wed, 12 Oct 2016
Question: My issue started 11 weeks ago and I am not sure what triggered what is happening to me. 11 weeks ago I was actually recovering from a pulled muscle in my lower back and was doing much better. Well I tripped and kind of aggravated the muscle. I laid down on my heating pad and just cried for a few minutes because it hurt and because I was so frustrated( we are in the process of selling our house and buying another and with hurting my back a couple weeks earlier and the stress of things , it just got to me). Well my back felt better after about 20 minutes and so I was able to go about my day. My nose ran and was a little stuffy after I cried which is normal and it usually will go away after a few minutes. I went downstairs to the basement apartment and started cleaning some( cleaning the sink and sweeping the floor). I then went out to the store. While I was out I noticed my nose started feeling a bit irritated. I just fluffed it off as maybe from crying it got irritated and figured it would go away in a little while. Well it did not go away. The next morning I sneezed a couple times and my left nostril was runny and irritated for about 20 minutes. The runny part stopped after that but my nose was still irritated and somewhat stuffy. It seemed to be getting a little worse as time went on. My main symptom was just a dry stuffy nose( the passages were swollen) Some days I would get this pressure feeling in my nose and around my eyes when I would go outside. I finally went to see an ENT doctor. He looked up my nose with a camera and said one side was pale and boggy which my be consistent with allergies. I also have a slight deviated septum but he said this was not my issues because I always have had that and the way this came on was not suggestive of a septum issue. He suggested Nasonex. The first time I tried the nasonex it felt like it irritated me more so I did not take it again. I called the doctor back and he prescribed me Medrol dose pack( 6mg) where you take 6 pills the first day then 5 the second day and so on until your down to one pill on 6th day and your done. I feel it did Not help me much at all. I went back to the ENT and he did a CT scan which he said the sinuses looked clear. He suggested I see an allergist. I went to see the allergist and she did skin testing. The initial test she did was on the forearms and they were pretty much negative. She then did the challenge test where they inject different allergens in 9 different spots on the upper arm with a needle just under the skin. I did not have much of a reaction to that one, at least not at first. The next morning I woke up and three of the spots on my upper arm where she injected me were itching and swelled up like mosquito bites. I called her back and she said it was a delayed reaction, but likely not allergic. She said an allergic response would have happened right away. She said maybe try nasacort. I did that for two weeks and felt No better. In fact maybe I felt a little worse actually. I finally stopped that. I tried neti- pot which does not help much either.

So here are my symptoms for last 11 weeks that just popped up out of the blue: Swollen nasal passages/turbinates, irritated passages, meaning they actually feel irritated. I also will get that pressure feeling in my eyes and around my nose when it is really stuffy. When I say stuffy, I am not referring to my nose being full of mucous, I do Not have any runny nose or mucous. It is just swollen inside. I do Not have a history of sinus issues at all. I Do have a history of other chronic health issues for the last 14 years though such as, ( Interstitial Cystitis (When I Was diagnosed with Interstitial Cystitis the doctor said my bladder appeared very vascular and dx me with Interstitial Cystitis( that was in 2006), Intestinal issues which come and go, fibromyalgia, odd skin rashes usually due to reactions to foods or medications I had taken etc..). I also have had inflammatory blood markers elevate from time to time like C-reactive protein and sed rate which my doctor was not too overly concerned about). Not sure any of this has anything to do with my current nasal issue though.

What could this be, and why is nothing helping me? The only thing that gives me a little relief from my nasal stuffiness is if I take oral Pseudophedrine. I only take it once or twice a week ( 60mg). I try not to take it daily as I do not want to get side effects from it if I were to take it daily. I feel my whole nasal passages are just swollen,irritated which is causing me to feel stuffy all the time. My guess is it is not allergy since the steroids did not help much, what is your thoughts on this? What else can I do? Could this be a infection of some sort ( fungal, bacterial)? Is it possible to have an infection of some sort without having lots of mucous?

The only things that happened prior to this was that I cried when I hurt my back, and cleaned a little in the basement. We have had a few things done around the house getting it ready to put up for sale in the last three months( My hubby stained a small area of wood, he had some dry wall replaced but that was outside on the upper back porch and I was Not in the vicinity when that was being done, we had our laundry room floor tile replaced but again, that was outside separate from our house and I was not in the area when it was being done, and just a lot of cleaning.) Not sure if that could have kicked this off, but it seems odd how it happened like out of the blue. I would think it would have calmed down by now if it were just aggravated by those things. What are your thoughts? It is 11 weeks and I am not any better. Here are the things I have tried thus far : Nasacort for two weeks, oral medrol dose pack, singulair, neti-pot, ocean nasal saline spray a couple times, I was on zyrtec before this whole thing started for a few years on a low dose( 5mg daily) and that was for skin itchiness I would get from time to time. I actually stopped taking that a couple weeks after this nasal swelling started thinking it was making it worse but no change. I have Not went back on the zyrtec as I figured it would not be of much help since the steroids did not even help much. Need advice on what to do. This is not typical and odd how it all just started out of the blue. I was fine before this happened, no nasal or sinus issues at all. What could be causing this?
doctor
Answered by Dr. Abubakar Siddiqh (37 hours later)
Brief Answer:
seems to be vasomotor rhintis.

Detailed Answer:

Hi,

I had gone through your question and understand your concerns that you are having nasal stuffiness and swelling since 11 months.

1. Based on your clinical details, it appears to be vasomotor rhinitis. (emotion/stress induces the nasal stuffiness). Allergic rhinitis or sinusitis ruled out with allergic tests/ ct scan and medications.

2. Vasomotor rhinitis occurs when the blood vessels inside your nose dilate, or expand. Dilation of the vessels in the nose produces swelling and can cause congestion. Mucus may also drain from the nose.

3. common triggers that may produce this reaction include: irritants in the environment such as perfumes, odors, smog, or secondhand smoke, changes in the weather and particularly dry weather, viral infections such as those associated with a cold or flu, hot or spicy foods or drinks, medications such as aspirin or ibuprofen.

3. Food allergies and sensitivities are also common with Interstitial cystitis. Research links a handful of foods and drinks to Interstitial Cystitis flare-ups.

In my opinion, you need stop the exposure to triggers and start corticosteroid nasal sprays such mometasone, antihistamine nasal sprays such as azelastine or olopatadine hydrochloride. Kindly discuss your treating doctor about this medications (allergic rhinitis and vasomotor rhinitis treatment is almost same).

Hope this answers your question, if you have additional questions or follow up questions then please do not hesitate in writing to us. I will be happy to answer your questions






Above answer was peer-reviewed by : Dr. Priyanka G Raj
doctor
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Follow up: Dr. Abubakar Siddiqh (8 hours later)
Thank you for the reply. I have actually only been dealing with this for 3 months now. It started out of the blue. I have no history of allergies or sinus issues. This just kind of happened like I mentioned in my first post, out of nowhere. It started with slightly irritated stuffy nose and just got worse as the weeks go on despite my trying many different things ( I tried nasacort steroid spray for 2 weeks with no results, in fact I felt worse on it), I tried bendaryl which did not help at all and felt worse with that, neti- pot, singulair, etc..

I am on a strict diet ( No gluten for years now, no grains, no sugar, no dairy). Not sure what else I could change in my diet. My Interstitial Cystitis is not bad right now thankfully. It is my nasal passages that are not good.

I am seeing an intergrative medicine doctor and she did a nasal swab which showed I have Marcons ( multiple antibiotic resistant coagulase negative staph) in my nasal passages. Could this be causing my nasal passages to be constantly painful and swollen for the last 3 months? I also have been getting pressure behind my eyes and around my nose at times as well. I do not have much drainage, but wondering if it is possible to have an infection without having discharge? It is odd that none of the treatments I have tried are helping at all. That makes me wonder if this is some kind of infection( bacterial or fungal). What are your thoughts on that?

doctor
Answered by Dr. Abubakar Siddiqh (18 hours later)
Brief Answer:
no signs of active infection.

Detailed Answer:

Hello again,

Thanks for considering my answer and for your follow up.

Answers for your queries.

1. Netipot for thick secretions for clogged nose and singulair for chronic allergic disorders.

2. Gluten free diet, no relation with vasomotor rhinitis.

3. Marcons ( multiple antibiotic resistant coagulase negative staphc0 infections, do CRP and complete blood picture to rule out the active infection.

4. Not Possible. sinus tenderness (behind the eyes) with out active nasal discharge or post nasal drip.

5. In my opinion, it looks purely vasomotor rhinitis (ct scan and allergic tests ruled out the active infection (bacterial or fungal)).

Hope, I have answered your query. All the best. Take care.

5.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
Answered by
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Dr. Abubakar Siddiqh

ENT Specialist

Practicing since :1994

Answered : 2038 Questions

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Suggest Treatment For Symptoms Of Vasomotor Rhinitis

Brief Answer: seems to be vasomotor rhintis. Detailed Answer: Hi, I had gone through your question and understand your concerns that you are having nasal stuffiness and swelling since 11 months. 1. Based on your clinical details, it appears to be vasomotor rhinitis. (emotion/stress induces the nasal stuffiness). Allergic rhinitis or sinusitis ruled out with allergic tests/ ct scan and medications. 2. Vasomotor rhinitis occurs when the blood vessels inside your nose dilate, or expand. Dilation of the vessels in the nose produces swelling and can cause congestion. Mucus may also drain from the nose. 3. common triggers that may produce this reaction include: irritants in the environment such as perfumes, odors, smog, or secondhand smoke, changes in the weather and particularly dry weather, viral infections such as those associated with a cold or flu, hot or spicy foods or drinks, medications such as aspirin or ibuprofen. 3. Food allergies and sensitivities are also common with Interstitial cystitis. Research links a handful of foods and drinks to Interstitial Cystitis flare-ups. In my opinion, you need stop the exposure to triggers and start corticosteroid nasal sprays such mometasone, antihistamine nasal sprays such as azelastine or olopatadine hydrochloride. Kindly discuss your treating doctor about this medications (allergic rhinitis and vasomotor rhinitis treatment is almost same). Hope this answers your question, if you have additional questions or follow up questions then please do not hesitate in writing to us. I will be happy to answer your questions