Rhinosinusitis

[Barbs80]

Hi there

Having suffered with asthma & rhinitis for years, I have attended ENT this year as my sinuses have been really bothering me which in turn affects my asthma. Today I had my second review at ENT & I wasn't completely happy with the doctor. He basically feels that it's just my asthma causing the sinus problem and vice versa and there is nothing really more I can do other than keep taking avamys nasal spray & inhalers. It has really been getting me down & I guess I'm fed up with people always thinking I have a constant cold! Anyone have allergic rhinosinusitis got any advice?

[IChoose]

Yes, I too suffer from a rhinoceros up my nose. Of course, if there is a rhinoceros up my nose, my asthma will be worse, but try explaining that to some doctors.

But seriously folks, the only thing i can use consistently in my nose is the Neil med bottle with the Neil need packets. I buy gallon jugs of distilled water for it. I have a trick that I put an Altoids mint in my mouth while I'm irrigating to help open the sinuses as the wash is going through. I take a couple more Altoids after the rinse is finished.

I also irrigate after cleaning up in the bath/shower.

I irrigate from once to 3-4 times per day.

Any steam that works for you is great.

I also like the sinus strips you stick on top of the nose to hold the sinuses open - can't remember what they're called.

My allergist understands sinuses and recommended Flonase Sensamist which has been helpful especially during pollen seasons.

I have heard some people use pulmicort respules in their Neil med to get gentle steroid into the sinus but have never been able to do it since the respules are very expensive.

My allergist also understands when I need antibiotics, which are a lifesaver. I used antibiotics a lot when I was younger. Now you really need a doctor who understands how hard it is to wipe out sinus infection.

Then, allergy proof your home, seal up your bedding to protect yourself from dust mites, get a true heppa filter for your home, at least where you sleep.

I have heard some recommend alkolol - it is sold in pharmacies - I never tried in case the ingredients could cause allergies.

Ensure you know what foods you are allergic to and you can try eliminating dairy if you're suspicious of it, or try lactose free.

You can try probiotics like culturelle, etc

You can try wearing a mask when you are outside, cooking, or dusting and vacuuming to see if that helps.

I use ibuprofen to help with the inflammation in my sinuses, even though there is an asthma risk with it.

I take theophylline and Mucinex 1200 for my asthma which also has a positive effect on my sinuses. I take Sudafed occasionally to break things up before it becomes serious, or to help a bit when it has, realizing there is a tipping point where Sudafed will exacerbate my asthma once the infection is really taking over.

If Kleenex fuzz is a problem for you look for a facial tissue that works for you or try blowing your nose in soft paper napkins instead of Kleenex.

Try to avoid carpeting and find out if you are allergic to pets.

I am chemical sensitive so have a Seventh Generation free & clear home.

Try not to get exhausted - I take melatonin sometimes to be sure I sleep. Sinusitis, no sleep, worse sinusitis is a vicious cycle.

Drink lots of fluids, especially hot fluids.

I like boiling vegetables for a simple vitamin rich vegetable broth - same for chicken soup.

[Barbs80 in reply to IChoose]

Thank you so much for this very in-depth response. Lots of things to try. My ENT really recommends the rinsing with NeilMed so I guess this is something I should. I do find steaming with Vicks gives me quick relieve but not long term. Thanks again 😊

[nickpeters]

Nasal sprays, especially ones purchased over the counter, will cause rhinitis if used frequently. Some years back I suffered from Hay Fever and became addicted to over the counter sprays. Since then I have met several people with the same problem. These 'over the counter' sprays are quite powerful and shrink the mucus membranes which then enlarge again so more spray is required creating an endless increasing circle. Sprays obtained via your GP should not cause these problems, but while they feel less effective, they do work in the long term.

In fact the hospital doctor was right, although perhaps somewhat lapse is offering constructive help. Post Nasal Drip and asthma do seem to go together, ask your GP for an alternative nasal spray (there are several available, keep going until you find the right one for you) to calm the rhinitis and things should improve with time.

The old fashioned inhalation also works well, add some menthol (or something similar) to a bowl of hot water and cover your head with a towel and inhale the steam for a few minutes. Don't get too close as you can scald the inside of your nasal passages.

Best wishes, have a nice Christmas,

Nick.

[Barbs80 in reply to nickpeters]

Thanks Nick, I have been on so many steroid nasal sprays and is just a matter of finding out which gives me the best relieve. I do find steaming with Vicks very effective. Thanks again Merry Christmas

[nickpeters in reply to Barbs80]

You are very welcome. Do have a great Christmas and hopefully a healthier New Year.

Nick

[Matman]

I suffer from Rhinitis accompanied (as seems to frequently be the case with many Asthmatics) with nasal polyps. The polyps I have are not the very obvious ones that are instantly spotted by nasal examamination, but rather the small ones that reside in the honeycomb of Sinus channels.

My specific phenotype of Asthma is Allergic, Eosinophilic, which is often accompanied by rhinitis.

Points discussed above are all / mostly focussed on symptom relief rather than cause resolution which, admittedly, is no straightforward task.

Endoscopic Nasal Surgergy can, among other things, increase the aperture size to sinuses to allow them to drain more effectively while at the same time removing any polyps present and correction of any septum deviation contributing.

My understanding is that, the better drainage and nasal architecture is achieved by these tactics, the fewer instances of stubborn infections giving rise to Rhinitis and, therefore, the less impact on Asthma.

Imagine you’ve had a CT and / or MRI to see if your sinus situation is so pronounced as to qualify you for surgery? (If not, that might be a good move, unless you know - from frequent long periods of symptom absence - that your sinus issues are intermittent / periodic, and not getting progressively worse).

Problem (if you do qualify for sinus surgery) is that,, in many cases, the benefit of surgery can be relatively short lived, with quite a number of patients only benefiting for a year or two (in some cases just months). Others, however, are more fortunate and may get several years of relief / benefit, with knock-on benefits for their Asthma. However, surgery should always be a last resort, as complications can and do occur, and therefore at least several hours of personal patient research should be undertaken to ensure full risk / reward knowledge is understood.

The surgery outcome may be improved if several courses of oral Steroids are given over the the months following the surgery. I would imagine that long courses of antibiotics given during the lead up to surgery and in the twelve months following might also help to maximise the longevity outcome / benefits. (As pre-existing, very stubborn nasal airway infection bacteria can sometimes take months of antibiotics to resolve). Obviously, if infections are viral rather than bacteria, then antibiotics will have no or little impact.

All that said, another option (if you qualify) is treatment by one of the new Biological Drugs (Moniclonal Antibidies) nicknamed MABs developed for Asthma Treatment, as one or two of these may help with the sinus issues too.

Where ‘Allergic’ Asthma is concerned, some MABs are showing promise in improving matters for patients in various ways, for example, at least partially correcting the IgE response that - in at least the case of eosinophilic allergic asthma (and possibly other asthma Conditions too) causes high release of eosinophils that appear to be a significant contributer to rhinitis.

At this time, NHS Patients in the UK may only qualify for MABs consideration if you Asthma is classified ‘severe’ (one Flag for which is having to take 4 Courses of Oral Steroid Tabs in a 12 Month Period).

In the UK, NICE have approved 3 MABs for Asthma, but these cost the NHS a packet to prescribe (5 Figures a year I gather). So, even though many Asthmatics want them, qualifying involves the factor already mentioned above plus (now it seems) a cost control hurdle that local area health authorities have / will be, putting in place.

In my case, my sinus conditions have worsened to the extent that my sense of smell is often missing. This also reduces sense of taste. These may seem like minor issues until you can’t smell or taste your food, your partners scent, flowers etc. I only mention this as significant deterioration in sinus health combined with nasal polyp development can take you to the same place. Temporarily relief for smell / taste can come in the form or oral steroids and / or very short term use of certain decongestion nasal drops (e.g. few days only to avoid rebound congestion).

Have tried daily nasal salt water rinses for a couple of months, but only once a day (half a pint per nostril via bespoke device) but have now stopped as saw no benefit - though I might try again. One concern I have with them is that they maybe flushing away not only any negative bacteria / virus presence but also mucus which is nature’s evolved way other thousands of years to trap and excel bacteria and viruses. There’s also the mater of any protective bacteria (assuming such exists) that may reside in the nasal passages.

I can see the sense of many of the ideas mentioned in the comments, but only in the context of temporary relief.

[WrenJen]

I have been doing the neil med nasal rinsing for about a year now on the advice of a consultant. Really helps me and I just do it more or less often dependent on need (anything from twice a day to every few weeks). Hope you get some relief x