Why do I always get blocked nose once I come home?

Hello,

Welcome to icliniq.com.

I have reviewed the photos you have attached (attachment removed to protect patient's identity) and based on the information you provided, it seems you are suffering from allergic rhinitis and chronic tonsillopharyngitis. You have a blocked nose and sneezing associated with climate or environmental changes, indicating allergic rhinitis. Apart from that, your nose appears to function well. Allergic rhinitis is a challenging disease, and finding a simple cure for it is difficult. However, acute episodes can be controlled with an antihistamine, with or without a Leukotriene antagonist. I suggest you take a tablet containing Fexofenadine and Montelukast or a tablet containing Montelukast and Levocetirizine to help control the allergy episode. For long-term relief, I suggest you use nasal sprays like Mometasone furoate or Fluticasone propionate. These sprays should be used twice daily in both nostrils for about a month, with the dosage gradually reduced thereafter. These steroid sprays reduce nasal inflammation and allergies. The definitive treatment for allergies is immunotherapy, but before that, we need to identify the specific substances in the atmosphere that cause the allergy. I suggest you undergo a skin prick test or an immunoCAP (quantitative test that measures the overall quantity of circulating immunoglobulin E in the blood) test to identify the allergens. Following this, vaccines of the same allergens can be administered in increasing quantities to help your body adjust to them without producing allergy symptoms. Moving on to your throat, there is granular congestion in the posterior pharyngeal wall, tonsils, and pillars. Additionally, the tonsils are covered with pus and calcified material known as tonsilloliths. These signs indicate a long-standing infection. Currently, I suggest you take a course of antibiotics without anti-inflammatory and antacid medicines. I suggest you take a tablet containing Amoxicillin and Clavulanic acid 625 mg twice daily for five days, along with tablet containing Trypsin and Chymotrypsin twice daily on an empty stomach, and a tablet of Esomeprazole 40 mg twice daily on an empty stomach. Furthermore, I suggest you gargle with diluted Betadine mouthwash three times daily for a week. In the long term, I suggest you undergo tonsillectomy surgery, which is a safe procedure. Tonsillectomy will ensure that your problems with tonsil stones and recurrent tonsillitis are resolved once and for all. Medication alone cannot cure tonsillar enlargement. If there is recurrent tonsillitis causing breathing and swallowing difficulties, surgery is needed. I suggest you consult a specialist, talk with them and take medications with their consent. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. The conditions where we advise tonsillectomy are very clear-cut. When the patient has recurrent tonsillitis (tonsil infection) or recurrent tonsilloliths (stones) or tonsils enlarge big enough to cause breathing or swallowing difficulty, we advise tonsillectomy. These conditions are somewhat relative as some people may choose not to undergo the operation but treat the disease through medicines alone. In that case, every time an infection occurs, you may take a course of antibiotics and anti-inflammatory drugs with gargles to control the infection. However, if such infections result in an absence from work or college for more than two weeks per year, we again advise tonsillectomy. In your condition, the stones have been there for more than three months and give a feeling of something stuck there. Hence, it is advisable to go for surgery. Of course, you may take the medicines I suggested and wait for five days. Take the full course of medicines for five days. Thereafter, if you get better, we can reassess the need for surgery. However, if the stones come back soon, we can proceed with surgery. For nasal allergy, you may take the tablets I mentioned in the previous conversation. I suggest you take one tablet at night. Also, use the spray I mentioned. Take one puff in each nostril twice daily, morning and evening. Continue the spray for two weeks, then reduce the dosage or frequency, and stop after a month. This will help keep your allergy in control. The definitive management of allergy involves allergen avoidance and the diagnosis of allergen sensitivities. This can be done through skin prick testing, which is the gold standard. You may visit any good hospital for allergen sensitivity testing using the skin prick test. Based on the results, we can start you on immunotherapy, which provides lasting relief in allergies. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. I went through the pictures you attached (attachment removed to protect patient's identity) Your doctor has given you the right medicine. In fact he has given the same medicines that I suggested to you except for the antibiotic. I had suggested you tablet containing Montelukast and Levocetirizine or Montelukast and Fexofenadine for immediate control of allergy. Your doctor has given same medicine of different brand and his medicines serve the same purpose. Second, he has prescribed Fluticasone propionate nasal spray which is similar to the nasal spray that I suggested. He has given you a good multivitamin tablet to help healing and promote immunity. This is a supportive measure in addition to definitive management. Next, he has given a antacid which I had suggested as well. To relieve you of the pain he has given you painkiller as well. So, in effect the management is essentially the same. We do not suggest skin prick tests and immunotherapy at the first visit. There is a protocol. When you take the medicines for the prescribed duration and still you do not find cure, then we go for investigations like skin prick testing and in-vitro testing. Since you were worried about finding a cure for allergy, I suggested the options. But there is nothing wrong in what the doctor has given you. Do take the medicines as he told. Since he has seen your throat and not written an antibiotic, you would not be requiring one. So you need not take antibiotics. Remember that skin prick testing is to diagnose which allergens are causing allergy and immunotherapy is vaccine against those allergens. We do this only if allergy is not getting controlled using nasal sprays and anti-histaminic medications. I would again reiterate that allergen avoidance is the best way to deal with allergy. An additional advice I suggest is you start writing diary every single day with special emphasis on the places you visit, food you consume, development of sneezing or running nose. When you do that for few months you will have made a list of places, food items and situations which cause allergic symptoms in you and thereafter you may avoid these situations. For now do take the medicines the doctor has given you for the prescribed duration. Meanwhile any issue or problem you have you can always contact me. I will clarify the same and also provide you all details in a simple understandable manner. If you would like to know how and when to take the medicines, I will help you with that. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.