..okay, calling all medical specialists and those who've experienced this before. I have a friend who has an allergy problem since very2 young. However, my friend also has a breathing/nose problem. It can get so bad, that the head, nose and ear ache appear constantly. My friend already consulted with several doctors/specialists but they all came up with different suggestions. Here are the options my friend could take: 1. Surgery. Downside, more expensive, as it requires general anesthesia and need to stay abt a week for additional monitoring. 2. Catherization. Donwside, once cleared it will be affected by allergens. 3. Take more steroids (oral, spray) to alleviate the breathing problem. Downside, it'll damage the body even more, even harming the bones. It gets even worse when my friend flies on an airplane. Which one is the best, long term? Appreciate for any suggestion(s).
I would suggest that your friend seeks more medical opinions in the hope of establishing a consensus. As a general principle, it's better to try conservative measures first. There are many possible treatments of sinusitis. At the conservative end, you can flush salt water into the nose, or try various other medicines intended to relieve the symptoms; at the invasive end, you have surgery. Topical steroids occupy a middle ground; your friend should discuss the possible side effects with a doctor. It's worth noting that sinusitis can be caused by allergens. There may be a connection with your friend's allergy. Surgery is more likely to be effective if the cause is anatomical (say, unusually narrow sinus passages). Make sure that he understands the argument for surgery before proceeding.
^^Thanks for the input..^^ - Yes, my friend had asked 5 different doctors/specialists abt it. But no real consensus. Actually, the specialist who suggested to have the surgery has been the longest doctor my friend has dealt with. The doctor only said, the only "real" cure to the illness is to have the surgery, because just doing the cauterization is only temporary. As a matter of fact, my friend had tried that method before but is now in the current conundrum. Just looking for more inputs here cos i know there are a couple or so BC doctors. *Sorry, it should've been cauterization. Not catherization. - Yes, my friend already know the side effects/downside of each option (as described above). Already tried everything except the surgery. - Yes, my friend has allergy problem since very2 young. But the nose/breathing problem makes it worse. - Here's the deal abt my friend's situation. My friend recently went to see a family doctor who inserted a tiny camera and the family doctor suggested to take steroids (spray & oral), plus allergy medicine plus high dose of pseudoephedrine plus 2 weeks of antibiotics (yes, that's how much drugs were taken). Then a couple or so months later, my friend went to the specialist (who's been the primary specialist) who inserted a tiny camera and found a couple white bulges. Upon finishing, the doctor seemed to have a grim look. Doctor suggested to do a full head scan to find out what they might be. Fortunately, after the scan, the doctor came out w/a happy face and and said they are not tumors. The doctor said he just had a patient like that, turned out it was brain cancer. The CT scan showed one of the sinus cavities isn't empty as they should be. Probably the main reason my friend has been getting all those head, nose and ear aches cos not enough oxygen. The doctor knew my friend was pumped w/all sorts of meds so the doctor just gave new steroid spray cos the old one gave serious bloody nose. Basically, one of the sinuses is filled up with those white infection bulges. Hope that clears up a bit more..
It sounds like more investigation is needed. If a sinus is filled up with "white infection bulges", then he needs to discover the nature of the infection (assuming it is an infection). If the infection is bacterial, then antibiotics may treat it. If it is viral, however, then antibiotics will have no effect. If the doctors don't know what these bulges are, then an obvious possibility is to take a tissue sample. It should be possible to do this by exploratory endoscopy (it should not require surgery). Basically, get more information.
Sinuses can be extremely complicated problems. If your buddy's surgeon says he needs surgery, he probably does. Just out of curiosity, has you allergic friend ever used one of the leukotriene receptor antagonists (montelukast or zafirlukast)? They are not miracle drugs but occasionally they result in improved symptoms for those cases who only partially respond to antihistamines. (though not necessarily for those with "white infectious bulges" )
Sounds like nasal polyps to me. I think you can already see which one will solve the problems. How many years has your friend had the condition? He has tried the other treatments, sooo which one gave him best relief and which one got rid of the polyps long term.....? For your original post, you didn't mention the advantages of each treatment You need both disadvantages and advantages to make the decision.
It is probably nasal poyposis; it is often associated with recurrent allergic rhinitis and sinusitis. A trial of oral corticosteroids may sometimes clear the nasal polyps but often surgery is needed; note topical pseudoephidrine should not be used for >3 days as it may result in paradoxical worsening of nasal congestion due to rebound effects. Surgery will result in immediate improvement of nasal symptoms and improve drainage of the nasal sinuses and hence alleviate the persistent sinusitis (which accounts for the opacification of the sinuses seen on CT or Xray); antibiotics, nasal douche, steam inhalation, mucolytics are medical therapy alternatives but if the underlying anatomical obstruction is not treated, your friend will be predisposed to recurrent sinusitis in future. The mainstay of treatment for allergic rhinitis is allergen avoidance, intranasal corticosteroids and anihistamines; leucotriene receptor antagonist may help as well though there is a contentious association with Churg Strauss Syndrome if used. The allergen reponsible may sometimes be ascertained by skin prick tests where small amounts of various allergens are injected into the subcutaneous tissues and the skin is assesed for a wheal/erythema (present if the individual is allergic to that substance).
A few possibilities in the differential diagnoses, which are not necessarily mutually exclusive: 1. Allergies To various environmental allergens, eg. dust mites excrement(!), pollen (grass, trees, etc), cats/dogs saliva protein, etc. Short term treatment: intranasal steroid sprays. Don't worry about side effects because very low microgram doses and not much absorbed. Also antihistamines (like cetirizine, desloratidine) and the newer leukotriene receptor antagonists (montelukast or zafirlukast, as Fidget mentioned) are very helpful. Long term treatment (ie. cure): desensitization program, with monthly subcutaneous injections to force the body and immune system to adapt/accept the specific allergens instead of rejecting it. Over 2-3 yrs, this would significantly reduce the allergic reactions, hence "desensitized". Downside, only effective in 80% of cases and time consuming having to go to the doctor's office monthly. 2. Nasal polyps Usually but not necessarily caused by allergies. Only definitive treatment is surgery, although some would try cautery first. 3. Chronic sinusitis Can be caused by chronic allergies due to chronic congestion. Cultures should be taken to provide guidance to the right antibiotic to use, if needed. Nasal saline lavage and intranasal steroid also helpful. But if allergies were the cause, then that has to be treated too. 4. Deviated nasal septum Definitive treatment is surgery. Hope that helps.
Thanks for the inputs.. - After i gathered more infos from my friend, apparently there is no infection & no white bulge. In the 2nd prognosis (when they inserted the tiny camera), the specialist thought it was a "white bulge-like tumor". But after CT Scan, it wasn't a tumor. But it turned out to be a white area(whatever that means) consistent w/allergy sufferer. My friend didn't tell me whether they've taken tissue samples or not. - I don't know why the doctors have been giving my friend antibiotics if there is no infection. ..thanks for the input. Yes, sinus problem is complicated enough w/out allergy sufferer like my friend. - As for those 2 drugs/meds, my friend can't confirm but i would guess my friend has tried either or both. Again, my friend is a long time allergy sufferer. - What my friend is experiencing now is constant pressure & congestion esp. after a flight. For some reason, it's gotten a bit worse. When sleeping, the pressure worsens, tears would flood out and post nasal drips would go through and choke the throat. My friend will take the meds in next couple of days and if still in pain, then will undergo the cauterization method. Of course, doing so will increase more susceptibility to allergens. ..thank you for the input, Dr. Cheung. - Yes, that's what my friend and the specialist thought after the CT Scan. Could be either a polyp or cyst. But even after surgery, how to prevent it from growing again? - Yes, from what my friend told me, there is a consensus on what might be the cause or what's causing it. However, it's just that they don't have the consensus on what's the best way to help my friend, long term. It's just frustrating for my friend. - Like already mentioned, my friend has had this allergy problem since very2 young. The nose/breathing problem started later. Probably as a result of the amt of meds taken. - Also already mentioned, my friend tried the cauterization method once before (just to damage the tissue that's swollen) but it only lasted for a few months. - My friend only gave the disadvantages/downsides because the only other option which hasn't been taken is the surgery. Of course, only 1 specialist suggested the surgery as a long term solution. ..thanks for the input. I will pass this along to my friend eventhough my friend already knows about it. My friend probably took all those meds and in Dec. could hardly even walk because of the pain in the right leg. Doctors told my friend, the bones could be affected. Yes, my friend told me, most likely they'll need to do some allergy tests but once my friend is off the meds. It requires some clean time from allergy meds. Btw, szekt, are you also a doctor or a specialist in the medical field?.. ..thanks for the input.
I'm not an ENT doctor but that sounds a bit like radiofrequency ablation of the turbinates. The excessive tearing is probably due to blockage of the Eustachian tubes. IF he really does have nasal polyposis, and does have surgery, yes, the polyps can regrow and symtoms return. Of course, you have all the risks of surgery as well. But your friend has to just look at the potential benefits as well to make the decision. i.e. reduction of blockage, less postnasal drip, flights easier, not affected so much during daytime work. IF medication cannot control the symptoms, then obviously, other solutions need to be considered. I suggest getting other ENT surgeons opinions. In the US, I know a quite a few have subspecialised into cosmetic surgery so I be less inclined to visit one of those.
It does seem that your friend needs to solve his allergy problem if he is to be free of this afflliction in the future. As someone else said, go to an allergist to get skin prick testing to see what he reacts most to, then those are the allergens he needs to avoid, eg. cat/dog, dust, pollen. If unavoidable (I know of some cat lovers who are severely allergic to them and yet unwilling to give them up!), then a desensitization program would provide a long term cure in 80% of cases. For his nasal polyp(?), he'll need corrective surgery.
.. ..thanks for the input. - Yeah, the blockage of the Eustachian tubes could be nothing more than skin/dead flesh. I'm not sure if that re-grew after an earlier cauterization. If the polyp regrows, after the surgery/cauterization, then how to stop the regrowth?..Fortunately it's only in one of the sinuses.. That's the conundrum with my friend. If surgery won't completely heal it (chance of another regrowth in the future), then it'll be a big cost. Then might as well just do cauterization... - If not mistaken, the specialist for my friend is an ENT surgeon. ..thanks for the input. Btw, are you also a doctor or work in the medical field??..
I am quite confused.... It is common to get "pale areas" at the turbinates for sufferers of allergic rhinitis; in fact the turbinates are often swollen and result in nasal obstruction (BTW all people have turbinates in nasal passage); this however is different from nasal polyps which are almost like fleshy outgrowths, likely in response to repeated inflammation; since your friend 's Dr is an ENT surgeon, I presume he knows what he is talking about; Agree with Cheung that your friend likely has Eustachian tube dysfunction; treatment involves reducing secretions via treatment for allergic rhinitis and Valsalva manouevre. Ultimately, the root of the problem is clearance of the secretions in nasal passage and improvement in the plumbing ie drainage of the sinuses. Operation ie FESS helps to trim the nasal polyps but at the same time opens up the meatus of the sinuses to allow more efficent drainage. Of course, it does not treat the allergic rhinitis per se but certainly helps in symptom reduction due to the improved drainage.
Sorry to be picky re Cheungs post, but he's not experiencing extra tears because of blocked Eustachian tubes (from ears to throat) but from a blocked nasolacrimal duct (eye to nose). Agree with szekt that surgery is best bet.
My bad. You are very correct No idea why I picked the wrong word there Sigh. too early in the morning
You cannot completely prevent regrowth but the symptoms should get a lot better. Polyps can grow anywhere (in the body) and anytime - you cannot stop them. Let them get too big and they produce even worse effects. But, the point is that you should get good symptom relief for many years (and therefore much better quality of life) The effect is made better because of the better drainage of the sinus as described. I haven't noticed FESS being an operation that is often repeated. Sometimes, it might need to be done again a number of years later but I don't see it happening very often. (Unless the surgeon didn't clear out too much the first time round).
agree with most of what is said here consider too the possibility of allergic fungal rhinosinusitis and the differential diagnosis of mucormycosis, a.k.a. zygomycosis ( the latter specially if your friend is diabetic). otherwise it does seem to be chronic sinusitis with nasal polyposis for which much of the therapeutic interventions have already been discussed above. hope your friend feels better soon.
thank you, again, all for the inputs.. ..alright, thanks again for the extra votes to suggest for surgery; i'll pass all those along. On that note, though surgery is the likeliest way out to "clear out" the sinus/nose/breathing problem, my friend mentioned there's still the allergy to deal with, itself: 1. Still needs to take allergy meds.. 2. Allergy meds don't heal the problem, only provide relieve.. 3. There are no cures for the allergy(ies)..
Yes, there is .... at least better than a lifetime of taking allergy pills and nose spraying. It's desentization, as I mentioned earlier. Determine the specific allergen via skin testing, then inject that subqu in gradually increasing concentrations to force the immune system to adapt to the allergen. It may take 1-2 yrs to notice significant improvements, but this is the only long term cure... short of complete avoidance of the allergen, eg. cat/dog, specific trees/pollen. But some people can't/won't give up their pets or relocate to a different part of the country/world...
^^Thanks again for the input..^^ ..yes, my friend has heard of that a long while back and had considered it. But a couple of his doctors also mentioned it doesn't really work cos say, if my friend is allergic to pine nuts, after desensitization might be okay to pine nuts but the allergy would switch to another type of nuts...he'll give it a try this time around.. anyway, for now, my friend decided to undergo the cauterization method again, for both nostrils. yes, it'll be painful but at least will get some relieve from the constant pressure/headache etc.
