Dr. Gott: Nose runs amok
DEAR DR. GOTT: I am a 79-year-old male who has a chronic runny nose, diagnosed as vasomotor rhinitis. An ENT doctor told me that it is incurable. I have tried at least 10 different nasal sprays, the most recent being ipratropium bromide. It helped for a while, but is no longer effective. Any suggestions?
DEAR READER: Vasomotor rhinitis occurs because the blood vessels in the lining of the nose swell. This stimulates the mucous glands in the nose, resulting in a chronic stuffy/runny nose. While not harmful, the condition can be extremely annoying.
Causes vary from person to person but can include medications, weather changes, specific foods, irritants in the air and chronic health conditions. Perhaps if we consider each possibility, we can zero in on the cause of your rhinitis.
Medications, including aspirin, ibuprofen, sedatives, antidepressants and those taken for hypertension, erectile dysfunction and oral contraceptives, can trigger activity. Even the decongestant nasal sprays you have tried can cause negative symptoms.
Changes in temperature and humidity can cause nasal membranes to swell, resulting in a runny nose.
Specific foods, primarily those that are spicy, and alcoholic beverages, such as beer and wine, trigger such activity.
Irritants in the air you breathe – perfumes, pet dander, secondhand smoke, chemicals from a nearby plant or factory, dust, flowers in bloom and a host of other triggers – can be to blame.
Lastly, medical conditions such as nasal polyps, middle-ear infections, stress, hypothyroidism and hormonal changes can be to blame.
A physician listening to the presenting symptoms will likely make the diagnosis; he or she may have to rule out the possibility of allergies through skin or blood testing. During skin testing, the skin is exposed to small amounts of common airborne allergens, such as those from pollen, cats, dogs or dust mites. Blood tests measure the amount of specific antibodies in the blood. In an attempt to rule out sinus issues, a CT scan, a form of computerized X-ray, or nasal endoscopy, accomplished with the assistance of a fiberoptic camera, might be ordered.
Treatment will depend on the severity of symptoms. For some, over-the-counter or prescription decongestants will reduce congestion and narrow nasal blood vessels. Nasal sprays, of which there are many, include saline, antihistamines, corticosteroids and decongestants.
Because symptoms can last a few hours or a few days, appear almost constantly or are more pronounced at a specific time of the year, I recommend the following. Keep a journal of when an attack occurs and what preceded it. Did you inhale exhaust fumes while riding behind a diesel truck on an interstate highway? Did you eat spicy foods at a luncheon buffet? Did you have a visitor who smokes? Did you visit a friend who has a woodstove for heat? Are you on a beta-blocker medication for hypertension? Are there similarities in conditions that precede each attack? If so, try to identify them and then make further attempts to avoid the possible trigger(s).
To provide related information, I am sending you a copy of my Health Report “Allergies.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.