Hello,
Thank you for your query at DoctorSpring.com
I can understand you problem
You are suffering from bilateral nasal obstruction with post nasal drip for 2 months, you are also suffering from gastritis, tension headache.
Your CT PNS shows mild sinusitis, so these symptoms are mainly of allergy. You can start fexofenadine and monteleukast for 2- 3 weeks.(Allegra M 120 mg in night). You should use steroid nasal spray two times daily for 6 weeks.
You can do steam inhalation twice.
For reflux with PPI you should follow antireflux measures and life style changes including avoid alcohol, smoking, excessive tea, coffee and spicy food. This will help in headache also.
Hope this helps,
Feel free to discuss further,
Best regards
Dr. Sunil Jalan
MBBS, DLO,MS(CMC,VELLORE)DNB(ENT),DAA,MBA(HM)
Patient replied :
Hi, the main reason I posted this was because the medication was not working. Why would switching to fexofenadine be better than any other antihistamine. I am already taking montelukast (singulair) and using steroid nasal sprays. It simply doesn't help much. Is there another possible cause besides allergies? If it is allergies and the medications are inadequate, what else can be done? Also, sometimes I cough out little tonsiliths that smell horrible. How is the gag reflex related to the allergies? If there is inflammation in the throat/adenoids/uvula, will this get better if the post nasal drip is brought under control? Is it the post nasal drip causing the inflammation or direct contact with the allergens? Should I consider surgery to take out the tonsils, adenoids or uvula? The gag reflex is tough to deal with and it feels a little difficult to breathe (I thought this was because of my distended belly from gastritis but I dunno anymore) Can I expect the allergies to get better, worse, or no change over time? How promising do you think getting allergy shots is for my condition? What kind of side effects do the steroid sprays have? I read somewhere that they can interfere with the function of the cilia which seems counterproductive to me.
regarding the reflux, it is duodenal gastric reflux (reflux of bile into the stomach, not acid into the esophagus, the mayo clinic website suggests that PPIs are not suited for this problem.
The tension type headache is a TMJ dysfunction, my family doctor said that after applying pressure to my joint and my dentist says I grind my teeth a lot which I think confirms it. My doctor pressed my face at the sinus regions and it wasn't painful. I do not drink coffee, only rarely drink alcohol (at dinner with friends are parties but I don't drink much anyways).
Thanks for your reply but I don't think it really brought anything more to what I already knew.
Hello,
Only extra benefit with fexofenadine is that it is less sedative, so when we use antihistamines for longer duration it is preferred, but truly no extra relief in symptoms. Other then allergy it can be vasomotor rhinitis, that's why I included SMD in treatment option. Your symptoms are not classical allergic( sneezing and watery nasal discharge).
Allergy shots doesn't give any immediate relief, it takes minimum 6 month s for any response, that only in proven allergy.
For bile reflux you need to get consultation from gastro specialist. Steroid spray are quite safe to use for long term.
I know I have written almost same medication, but these are available choices in medical management, surgical options requires if no improvement with medicine including turbinate reduction by diathermy ( SMR). Tonsillectomy will help in tonsillolith. Steroid nasal spray doesn't have any significant side effect.
Hope this helps
Dr. Sunil Jalan
MBBS, DLO,MS(CMC,VELLORE)DNB(ENT),DAA,MBA(HM)
Patient replied :
Hi
what does SMD stand for? What causes vasomotor rhinitis? What is used to treat vasomotor rhinitis? Once the post nasal drip is stopped, will the swelling of the uvula stop? The Benadryl has been pretty good at drying me out, but it dries out my mouth as well, I'd like the swelling to go down so I don't feel the gag reflex and then I can bring down the dose on the antihistamine. Are post nasal drip and tonsiliths related?
thanks
Hello,
SMD is submucosal diathermy of inferior turbinate of nose to increase space in nose to get relief from nasal obstruction.
Exact causes of vasomotor rhintis are not known, it is mostly due to irritants including pollution, smoke,spicy food,and emotional changes.
Uvula swelling will not increse or decrease with postnasal drip changes.
Tonsillolith in not related to post nasal drip, it is due accmulation of food particle in tonsillar crepts, this will improve with gargle, or if this is causing recurrecnt tonsil infection or intolerable halitosis (bad breath) than tonsillectomy can be done.
I hope this helps answer all your queries,
Best regards,
Dr. Sunil Jalan
Patient replied :
What is used to treat vasomotor rhinitis? I live in Canada and the air here is pretty good. No one in my household smokes and I don't eat spicy food. The symptoms do not correlate with my emotional state.
Benadryl seems to help but I have to take 150mg every 12 hours which is unsustainable because it sedates me for around 1-2 hours.
Fexofenadine didn't seem to help.
To other people I don't have bad breath, probably because the tonsils aren't that bad.
Hello,
Treatment for vasomotor rhinitis is same only including antihistamines, nasal steroid sprays.
Benadryl/ cetrizine and fexofenadine all are antihistamine, from more to less sedative. But you are correct benadryl give better results in vasomotor rhinitis and different people have different results. If benadyl working for you, you can continue for some time, slowly this sedation effect will be less intense.
You can try saline nasal drops or spray also.
you should avoid sniffing or pushing secretion posteriorly in mouth.
If medical management fails then only you need to consider for SMD or other surgical options.
Hope this helps
Best regards
Dr. Sunil Jalan
MBBS, DLO,MS(CMC,VELLORE)DNB(ENT),DAA,MBA(HM)