Medical Forum / Diseases and Disorders / Sinusitis / February 2005
Chronic Post Nasal Drip
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5438 - 24 Jan 2005 06:34 GMT I've had year-round post nasal drip now for the past 2 years ever since a case of very bad sinusitis.
It chokes me at night and I cannot sleep. I have had several laser turbinate reductions done but the post nasal drip continues. My ENT is at a loss to explain what's going on. I'm losing confidence in him.
If it's allergies, howcome the turbinate reduction is'nt stopping the mucous from dripping down constantly? Also, when I blow my nose there is very, very little mucous in the tissue paper but constant post nasal drip. How can this be?? When you blow your nose, aren't you emptying out the inferior turbinate? The ENT thinks the inferior turbinate (left and right) is where the post nasal drip is coming from.
I live in the Santee, California area.
-5438
Don Brady - 24 Jan 2005 06:45 GMT >I've had year-round post nasal drip now for the past 2 years >ever since a case of very bad sinusitis. [quoted text clipped - 8 lines] >my nose there is very, very little mucous in the tissue paper but >constant post nasal drip. How can this be?? Your sinuses are huge cavties in the head. Some of them may or may not be full of fluid and infection. A CT scan will show if that is the case.
Turbinate reductions are just minor surgery in the hope of improving air flow, and may or may not help open up the sinuses.
>When you blow >your nose, aren't you emptying out the inferior turbinate? No the turbinate is a large baffle that does not contain a cavity. It can block the drainage from the sinuses though.
>The ENT thinks the inferior turbinate (left and right) is where >the post nasal drip is coming from. Well it may be blocking the sinus drainage.
Have you had a CT scan done?
>I live in the Santee, California area. > >-5438 5438 - 24 Jan 2005 16:55 GMT > >I've had year-round post nasal drip now for the past 2 years > >ever since a case of very bad sinusitis. [quoted text clipped - 6 lines] > >my nose there is very, very little mucous in the tissue paper but > >constant post nasal drip. How can this be??
> Your sinuses are huge cavties in the head. Some of them may or > may not be full of fluid and infection. A CT scan will show if that is > the case. > Turbinate reductions are just minor surgery in the hope of improving > air flow,and may or may not help open up the sinuses.
>>When you blow >>your nose, aren't you emptying out the inferior turbinate? > No the turbinate is a large baffle that does not contain a cavity. It can > block the drainage from the sinuses though.
>> The ENT thinks the inferior turbinate (left and right) is where >> the post nasal drip is coming from. > Well it may be blocking the sinus drainage. > Have you had a CT scan done? CT scan is clear. (had two of them) The maxillary sinuses are clear. My nose is not blocked or stuffed up at all and I breath very well. There is no sneazing or runny nose.
Where would the post nasal drip be coming from and why is my ENT so set on doing laser reductions? Has he run out of other options and doesn't want to admit it to me? The post nasal drip is killing me and I have to stop it.
-5438
Don Brady - 24 Jan 2005 21:42 GMT >CT scan is clear. (had two of them) The maxillary sinuses are clear. Wow that's a lot better than most of us here!
>My nose is not blocked or stuffed up at all and I breath very well. >There is no sneazing or runny nose. > >Where would the post nasal drip be coming from and why is my >ENT so set on doing laser reductions? I would not do laser reductions. See Dr. Grossan's comment before appended below. There is risk that you can reduce the turbinates too much and that can cause major problems ("empty nose syndrome").
> Has he run out of other >options I think maybe so.
>and doesn't want to admit it to me? The post nasal drip >is killing me and I have to stop it. Irrigation might clear it. I think it would help a lot. See http://www.sinusitisfaq.org/
You should probably be using a steroid spray (Nasonex or Flonase or other).
============================================= From: entconsult@aol.comnospam (ENTconsult) Newsgroups: alt.support.sinusitis Date: 25 Aug 2004 15:11:34 GMT Subject: Re: Sinus Surgery:Laser Message-ID: <20040825111134.04880.00002404@mb-m24.aol.com>
Sinus surgery via Laser is simply a gimmick, an advertising term. If you see an ad promoting sinus surgery by Laser! - run away. Laser is no different than a hot knife when it comes to sinus surgery. Practically we only use it for bleeding or some inaccessable areas. When its used for turbinate reduction, that's when you get empty nose syndrome. It can be used during sinus surgery but is no different than a cuatery or a knife. Murray Grossan, M.D. http://www.ent-consult.com
5438 - 25 Jan 2005 00:13 GMT > >CT scan is clear. (had two of them) The maxillary sinuses are clear. > Wow that's a lot better than most of us here!
> >My nose is not blocked or stuffed up at all and I breath very well. > >There is no sneazing or runny nose. > >Where would the post nasal drip be coming from and why is my > >ENT so set on doing laser reductions?
> I would not do laser reductions. See Dr. Grossan's comment before appended > below. There is risk that you can reduce the turbinates too much and that can > cause major problems ("empty nose syndrome").
> > Has he run out of other > >options > I think maybe so.
> >and doesn't want to admit it to me? The post nasal drip > >is killing me and I have to stop it. > Irrigation might clear it. I think it would help a lot. > See http://www.sinusitisfaq.org/
> You should probably be using a steroid spray (Nasonex or Flonase or other). Tried them, no effect. My allergist (at the time) said to tell my ENT to inject my turbinates with steroids so they would atrophy ... does that make any sense?
In 2003 I had 2 surgeries: - drained right maxillary sinus of all pus and infection. - fixed deviated septum - removed ethmoid sinus - other miscellaneous sinus plumbing work - adenoidectomy
I irrigate with saline solution every day. Stress and excercise trigger more post nasal drip. All of this happened at once while sleeping over someone's house. The heater came on and 'something' came in through the air duct and all hell broke loose in my sinuses. The allergist said I "went past the threshold point" with my sinuses when that happened and I became chronically allergic to dust, apparently. (I has some skin testing -- dust was positive -- very strong)
Dunno where to go from here. When I try to sleep at night the drip comes down and causes my epiglottis to SPASM and cut my air off. Only valium (so far) keeps the epiglottis from spasming and allows me to breath and sleep.
-5438
Don Brady - 25 Jan 2005 01:13 GMT >> You should probably be using a steroid spray (Nasonex or Flonase or other). >Tried them, no effect. You might want to keep using them. They often only have an effect long-term and it is subtle.
>My allergist (at the time) said to tell my ENT to inject my turbinates with >steroids so they would atrophy ... does that make any sense? I think it is not commonly done any more.
>In 2003 I had 2 surgeries: >- drained right maxillary sinus of all pus and infection. >- fixed deviated septum >- removed ethmoid sinus How do you remove a sinus since by definition a sinus is a cavity?
>- other miscellaneous sinus plumbing work >- adenoidectomy Are you an adult? If so there is no reason to do an adenoidectomy. I mention it only because it makes me wonder a little about your surgeon.
>I irrigate with saline solution every day. >Stress and excercise trigger more post nasal drip. I suspect you actually do have chronic sinusitis and some sinuses filled with pus (despite the CT scans). CT scans need to be carefully interpreted by a sinus specialist (not just by the radiologist).. I would get a hold of the actual films (not the report) and take them elsewhere for further opinions.
Stress and exercise just trigger the release of the pus, not the production of it.
>All of this happened at once while sleeping over someone's house. >The heater came on and 'something' came in through the air duct >and all hell broke loose in my sinuses. >The allergist said I "went past the threshold point" with my sinuses I doubt it. More likely you already had chronic sinusitis and the irritation just stimulated the release of it. That's the way my sinuses have behaved anyway.
>when that happened and I became chronically allergic to dust, apparently. >(I has some skin testing -- dust was positive -- very strong) [quoted text clipped - 3 lines] >my air off. Only valium (so far) keeps the epiglottis from spasming >and allows me to breath and sleep. I tihnk you need to get another opinion from a very experienced and well-thought-of sinus specialist at a major University medical center, for example. There are places like U.Penn. that do more extensive surgery than others when warranted. They know how to do it, others may not.
5438 - 25 Jan 2005 01:31 GMT > >In 2003 I had 2 surgeries: > >- drained right maxillary sinus of all pus and infection. > >- fixed deviated septum > >- removed ethmoid sinus > How do you remove a sinus since by definition a sinus is a cavity? It was stated in the medical records, IIRC, but I can double-check. The ENT is hard to talk to and evades discussions with me.
> >- other miscellaneous sinus plumbing work > >- adenoidectomy > Are you an adult? 47 year-old straight white male, 6ft. 215 lbs. athletic, work out, no drugs, no smoking or drinking, divorced
>If so there is no reason to do an adenoidectomy. I mention > it only because it makes me wonder a little about your surgeon. The post nasal drip was constantly causing it to get infected -- it had to go. (I still have my tonsils and the post nasal drip is rotting them out, also.)
> I suspect you actually do have chronic sinusitis and some sinuses filled with > pus (despite the CT scans). CT scans need to be carefully interpreted by a [quoted text clipped - 7 lines] > just stimulated the release of it. That's the way my sinuses have behaved > anyway. Never had a sinus problem before in my life until that one night in 2002 when I breathed 'something' in from that air duct. I woke up immediately and my mouth and throat were like sawdust and then all hell broke loose. My tongue has been coated greenish yellow ever since.
> >Dunno where to go from here. When I try to sleep at night the > >drip comes down and causes my epiglottis to SPASM and cut [quoted text clipped - 4 lines] > example. There are places like U.Penn. that do more extensive surgery than > others when warranted. They know how to do it, others may not. I'll try Scripp's in La Jolla, possibly. I have to do something.
-5438
Steven L. - 25 Jan 2005 20:55 GMT >>>In 2003 I had 2 surgeries: >>>- drained right maxillary sinus of all pus and infection. [quoted text clipped - 38 lines] > and my mouth and throat were like sawdust and then all hell broke loose. > My tongue has been coated greenish yellow ever since. Couple more things to try:
Have you tried a course of methylprednisolone (Medrol)? That may knock down the allergic inflammation caused by dust, even when steroid sprays fail. A minimally sedating antihistamine may help too.
Since you tested strongly allergic to dust, and since dust is ubiquitous, you MUST get a better handle on your allergy if you're going to help your sinuses.
Since you already have a history of chronic sinusitis, and had your maxillaries drained of pus, the simplest explanation I can think of for your problem is that there is still a tiny pocket of infection in any one of your sinus cavities that doesn't show up well on the CT scan. That was my experience. Twice already my surgeon found things during the course of sinus surgery that hadn't shown up on the CT scan.
My ENT noticed bits of pus on my turbinates and that was all he needed to convince him I still had sinus trouble in my sinus cavities, even though the CT scan didn't show any problem. You need to find an ENT who, like my own ENT, recognizes that CT scans aren't 100% reliable.
 Signature Steven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net
Remove the NOSPAM before replying to me.
MS - 04 Feb 2005 03:20 GMT > I'll try Scripp's in La Jolla, possibly. I have to do something. Try UC San Diego. They have (or had) something called the "Nasal Dysfunction Clinic", led by a well-known ENT, Dr. Davidson, I believe. I know they had a web site at one time, you might look it up on Google.
AL - 09 Feb 2005 20:36 GMT MS,
Is there a way I can contact you offline? I have a few questions for you regarding your septoplasty. If you're posting using google, just hit the reply to author and that should zip me an email. -a
MS - 11 Feb 2005 05:27 GMT > MS, > > Is there a way I can contact you offline? I have a few questions for > you regarding your septoplasty. If you're posting using google, just > hit the reply to author and that should zip me an email. -a Why not just write here to the group, so all can benefit from the discussion, if it turns out interesting?
Are you sure you are addressing this to the right person? I don't believe I have written about septoplasty any time recently.
When I had sinus surgery a couple years ago, the ENT also did a septoplasty, which I wish now he hadn't, as I ended up with a perforated septum as a result.
My only advice would be to be wary of septoplasty, only doing it if multiple ENTs are sure that a crooked septum is a major contributor to your problems, and straightening it will make a major difference in you symptoms.
Dball63 - 25 Jan 2005 17:56 GMT Just wanted to let you know that you are not alone with your problems. My symptoms are nearly the same as yours. I continue to fight it daily. I again plan a trip to Mayo clinic for next month. My local doctors in Sacramento, CA have not helped me at all in 5 years now! It is very frustrating I know.
David Sacramento, CA
5438 - 26 Jan 2005 03:12 GMT > Just wanted to let you know that you are not alone with your problems. > My symptoms are nearly the same as yours. I continue to fight it daily. > I again plan a trip to Mayo clinic for next month. My local doctors in > Sacramento, CA have not helped me at all in 5 years now! It is very > frustrating I know. Yeah, especially when it hit me so fast and hard, like a shotgun blast in the head from whatever came out of that air duct in late 2002.
Thanks :)
I'm going to get a second opinion ... it's time now.
Also thanks to Steven L. and LGV for your input, I'll discuss some of the suggestions with my current and new ENT/allergist.
That thing about the CT scan's possible failure to detect everything is a cause for concern.
-5438
ENTconsult - 31 Jan 2005 03:40 GMT Most post nasal drip is simply the mucus is too thick, because the cilia don't move the mucus blanket fast enough. Saline spry - without preservative may work. Hot tea to speed cilia may work. Ask your doctor if taking Clear.ease to thin the mucus to allow the cilia movement would help you. Murray Grossan, M.D. http://www.ent-consult.com
Don Brady - 31 Jan 2005 04:16 GMT >Most post nasal drip is simply the mucus is too thick, because the cilia don't >move the mucus blanket fast enough. Yes but isn't the slow cilia in turn usually the result of inflammation due to allergies or infection?
>Saline spry - without preservative may work. >Hot tea to speed cilia may work. >Ask your doctor if taking Clear.ease to thin the mucus to allow the cilia >movement would help you. LGV - 25 Jan 2005 16:37 GMT This may not apply to you, but have you been tested for food allergies?
After many medical tests and many specialist doctors, all of whom had no explanation for my many symptoms, the only thing that was known to be wrong with me was I had significant inhalant allergies. I asked my allergist to test me for food allergies. On the skin test, there was a very mild reaction to barley, which was enough to order a blood test. And on that blood test I learned I had significant & broad food allergies, the worst being corn, but also including wheat & barley & rye & oats & rice & peanuts & many fruits and vegetables.
Now, corn is used in the U.S. in almost every product you buy in the grocery store, including such ubiquitous things as iodized salt. It appears most often as corn syrup (for sweetener) or starch, but there are more than a hundred other common ingredients that are derived from corn (see http://www.cornallergens.com/list.htm).
Once I began eliminating corn from my diet, more than two dozen of my decade-long chronic symptoms disappeared. That includes excessive daytime sleepiness (my sleep doctor thought I had narcolepsy, but two sleep studies didn't confirm that); I discovered recently that I wasn't sleepy during the day when I tried Advair (an asthma inhaler) which seems to indicate lung inflammation somehow interfering with my breathing at night. I know when I accidently eat corn now because I feel my turbinates swell, I get sleepy, and I get a post-nasal drip -- it was only after I stopped eating corn that I realized my turbinates had been swollen my whole life and that post-nasal drip I got after eating was finally explained. My digestive problems disappeared, my skin cleared up, and I suddenly felt hungry again after years of not being hungry.
To make matters worse, corn also appears in many prescription drugs, even the allergy drugs I've been taking. Just today I learned that Rhinocort is made with either a wheat dextrose or a corn dextrose, and that explains the recent swelling of my turbinates -- I'd been lucky so far, apparently getting the wheat bottle instead of the corn bottle, but they can't guarantee which ingredient is in which bottle so I'm going to have to stop using it entirely.
But I apparently have a pretty unusual allergic reaction to food, my allergist tells me. Had it been more obvious, I would have seen an allergist 15 years ago instead of last year (I'm 33) and would possibly not have needed sinus surgery this year.
Something for you to rule out, given how miserable you must be.
ENTconsult - 27 Jan 2005 17:19 GMT Post nasal drip is essentially the mucus is too thick becasuse the cilia don't move the mucus out properly. Number one is to increase the amount of hot tea/lemon you are taking . Number two is to moisten the bedroom - best is simple evaporation by pans of water. If that doesn't do it, ask your doctor about pulsatile irrigaition to thin the mucus and help restore cilia action. Murray Grossan, M.D. http://www.ent-consult.com
Paminifarm CyberArt - 27 Jan 2005 22:17 GMT >Post nasal drip is essentially the mucus is too thick becasuse the cilia don't >move the mucus out properly. [quoted text clipped - 4 lines] >Murray Grossan, M.D. >http://www.ent-consult.com Hello, Yes, besure to do that "pulsatile irrigaition" so that it can plunge the infection so deep into your sinuses, you will need surgery for all the wonderful things that can happen as a result.
Go slow on that sort of thing, because there are also things living in water and water soaked areas that can cause trouble.
There is something called: Ayr, a jell, you can smear inside your nostrils (it too is a salt solution). That can get things running pretty good. Depending on how bad things are you may need a couple days or so. Besure to get Robitussin's green label with the one and only ingredient Guaifenesin Syrup, as that too will get things running in the right direction. Try zinc at the health food store also. Robitussin has more than one green label so besure you get the right one - that is important, because some of these medications DRY. You want WET. A mix up like that can kill an asthmatic. If and when you start sticking salt water soluition deep into your nose, get the little bottles of salt solution all ready made up at the drugstore. Then when the bottle is empty you can start making your own with sea salt at the health food store. Tell them you want no preservatives in the salt. You put 2 teaspoons to a pint of water. Remember to sterilize things once in a while, but always wash, rinse your applicators, and rinse again with alcohol and let dry. Please be careful . . . and good luck . . . http://lillyrouge.tripod.com/enter.html http://paminifarm.faithweb.com http://www.geezer.com/artisan/257
MS - 28 Jan 2005 03:45 GMT i don't see how turbinate surgery could reduce post-nasal drip. (Did your ENT promise that it would?) In fact, I think I have had more PND since my sinus and nasal surgeries.
The turbinate surgery is supposed to open up the nasal passages so that you can breathe better through them. It has nothing to do with phlegm draining from the sinuses into the throat.
> I've had year-round post nasal drip now for the past 2 years > ever since a case of very bad sinusitis. [quoted text clipped - 15 lines] > > -5438 Paminifarm CyberArt - 31 Jan 2005 21:57 GMT Hello, 5438, The drip may be coming from your ears. Mix a solution of half peroxide and half alcohol and with a dropper, carefully drop a dropperfull it into each ear. If you hear a lot of hissing you have ear-fungus infection. You also have fungus infection in your sinuses. The solution of peroxide and alcohol wil get rid of the ear fungus, however you will need something as Diflucan for the sinuses. Sorry i didnot see your original post until now.
Eddie - 12 Feb 2005 15:49 GMT > I've had year-round post nasal drip now for the past 2 years > ever since a case of very bad sinusitis. I have the same symptoms and have had four rhinoplasties. After the last surgery, I was allergy tested again (negative of course) and was told that the only diagnosis for this problem was vasomotor rhinitis. Thus far, I have been using Atrovent and Astelin with limited success and was told that there is nothing that can be done about it. After doing some searching on the internet, I found information in several Journals, i.e., Journal Laryngol Otol. 1980 Dec;94(12):1411-3 and others published later which suggest that cryosurgery (liquid nitrogen) can help reduce this fluid flow because it affects both the mucosa and the submucosa. Some report success rates as high as 54% and others suggest that further study might be necessary. I would like to know more from a doctor who has actually performed the procedure because I'm thinking of having it done if it might help solve this problem.
> It chokes me at night and I cannot sleep. > I have had several laser turbinate reductions done but the post [quoted text clipped - 12 lines] > > -5438
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