Patient's Query
Hello doctor,
I am on rebound congestion because of misuse of the nasal spray. I have used it for seven days, not knowing that it would cause me a rebound effect. My ENT doctor says to continue my spray due to my dry nasal congestion, I think.
Now I went back to him, saying that I had rebound congestion and my turbinates are swelling. He advised me to stop the spray, and he replaced it with Mometasone Furoate, two sprays once a day.
He also gave me Methylprednisolone two times a day for seven days and an antihistamine. I am now on my sixth day of withdrawal, the steroid spray works, and the oral he gave me provides relief. But I do not think that it reduces my turbinates.
Please help.
Thank you.
Hello,
Welcome to icliniq.com.
Why do you feel the turbinates are not getting reduced? Is it because you see those big things in the mirror? Is there any symptomatic improvement in the nasal block after the use of Mometasone? Turbinates usually increase and decrease in size a few times a day. Additionally, the nasal cavities also undergo regular congestion-decongestion cycles.
The rebound congestion that occurs due to decongestant nasal sprays is a temporary phenomenon. What might have happened in your case is rhinitis medicamentosa. But that occurs after months of usage of the decongestant spray and not in a week. We do frequently give decongestant drops for a week or ten days as indicated.
I suggest you continue with the steroid sprays. You may use a plain saline nasal douching a couple of times a day. Make sure to do this before using Mometasone, not after, as it would otherwise wash away the Mometasone. Nasal douching helps keep the mucosa clear and supple. It helps to improve the ciliary action of cells lining the mucosa and clear the mucus better.
That way, you appreciate the better movement of air inside the nasal cavities. Do revert back to me with more details. If possible, click a picture of the turbinates and get back to me. For now, if you were to come to me for a second opinion, I would continue with the medications you are on.
I hope this helps.
Kindly revert so I can assist you further.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
Yes, because whenever I check, my turbinate is still bulged. When I feel better, I notice if there’s more space than before. I can breathe fine through my left nostril, but my right nostril feels blocked all the time. Even before, my right nostril would block easily, and sometimes I had difficulty breathing after rebounding. There is a noticeable difference.
Whenever I use the steroid spray, my airway becomes clear. I want to know the following:
I have attached a picture of my turbinates. I think I need to flush them tomorrow. I already used Mometasone this morning and have taken my oral steroid. Right now, my breathing is quite fine.
Whenever my right nostril is blocked, I have difficulty breathing. Tomorrow is the last day of my Methylprednisolone, and I hope I can manage with just my nasal spray. Sometimes I feel suffocated, experiencing shortness of breath similar to asthma. This obstruction makes it hard to breathe easily.
My right ear also feels clogged at times, possibly due to the thick mucus. How can I get rid of that?
Thank you.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern.
Your turbinates are boggy and edematous (attachment removed to protect patient's identity). There is a superimposed allergic component also. You would need to take a steroid nasal spray for a month or two more, and whenever the problem or allergy occurs.
Additionally, you would have to take Allegra M (Fexofenadine hydrochloride 120 mg and Montelukast sodium 10 mg) one tablet daily for another month. A good mucolytic like Ambroxol (Ambroxol hydrochloride) will help lighten the mucus and make it go away better.
I hope this helps.
Please revert in case of further queries.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
I also want to know:
Thank you.
Hello,
Welcome back to icliniq.com.
I read your query and understand your concern.
Levomon D (Levocetirizine and Montelukast) is advisable. Allegra M (Fexofenadine and Montelukast) is less drowsy than Levomont. You can take either of the ones. It does not create any problem taking a period. You may feel thirsty, though. If there is excessive dryness, you may take it on alternate days.
But a long duration of the course is needed. It is safe to use Mometasone steroid spray, though it is different from the oral steroids you are taking. Nasal steroids have almost zero absorption into the bloodstream. They should act only inside the nasal cavities.
For the same reason, do not inhale immediately after spraying. Spray it when you are holding your breath and keep the breath held for another 10 to 15 seconds after spraying. You should be better.
I hope this helps.
Please revert in case of further queries.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
My nose feels very dry today, and it's hard to sleep in the middle of the night due to the dryness. Recently, my turbinates are not that boggy whenever I feel the dryness, except when they are congested.
Thank you.
Hello,
Welcome back to icliniq.com.
I read your query and understand your concern.
Continue using the medicines. The issue is an exacerbated allergy. You will be better in a couple of weeks with medications. Try doing saline nasal douching a couple of times daily to remove dryness. You may also instill some Paraffin drops into the nose for lubrication.
I hope this helps.
Please revert in case of further queries.
Thank you.
Patient's Query
Hi doctor,
Thank you for your reply.
I want to know:
Please help.
Hi,
Welcome back to icliniq.com.
I read your query and understand your concern.
If there is a nose block and congestion inside the nose, causing you to breathe with difficulty, then take oral decongestants like Sudafed (Pseudoephedrine) or Ephedrine (a central nervous system stimulant). Consult a specialist, talk with them, and take the medicines with their consent.
I hope this helps.
Please revert in case of further queries.
Thank you.
Patient's Query
Hi doctor,
Thank you for your reply.
Is it safe to take oral decongestants while using the steroid spray?
So, for now, I will not use a decongestant spray. And only oral decongestant is safe, right?
Hi,
Welcome back to icliniq.com.
I read your query and understand your concern.
It is safe to use with a steroid spray. Intranasal decongestant drops and sprays have very clear indications, and they should not be used continuously for more than a week. They have the property of rebound vasocongestion, causing the problem of rhinitis medicamentosa.
I hope this helps.
Please revert in case of further queries.
Thank you.
Patient's Query
Hi doctor,
Thank you for your reply.
Can an oral decongestant also cause a rebound? Please answer.
Thank you.
Hi,
Welcome back to icliniq.com.
Oral decongestant does not cause rebound. They have different mechanisms of action. So do not worry. But the oral decongestant also should not be used unscrupulously, as it can raise your BP (blood pressure).
I hope this helps.
Please revert in case of further queries.
Thank you.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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