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Q. Why are my sinus issues not subsiding even after the surgical correction of the deviated nasal septum?um?

Answered by
Dr. Shyam Kalyan. N
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Oct 20, 2021

Hi doctor,

I have been suffering from sinus issues for a while. I had surgery to open the blocked airways. But my nose is still swollen, my ears are ringing, and I could feel some discomfort in my nose. I do not get much discharge, and my nose does not produce any snot. These symptoms will subside for a while and reappear in a week or two. My nose swells up and remains infected for three to four days. Once I recover, it stays fine for another week or two, and it recurs.

I have tried eliminating all possible airborne allergies. I sleep beside HEPA filters. My house is spotless. And also, I modified my diet by eliminating dairy, gluten, and sugar. But I still have these issues.

I randomly noticed my food chunks go into my sinuses. I am wondering could the food particles go inside and get trapped in my sinus cavity. My body then reacts and blows up to rid of the foreign object. Is this being the reason for the ongoing cycle?

I used Claritan, Dymista, antihistamines, and steroid sprays, but nothing helped. I always wake up with a puffy nose and eyes. That has been an issue in the past year.

Kindly give your advice.

Thanks.

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#

Hello,

Welcome to icliniq.com.

Kindly help me know a few more details.

1) What surgery was done? Kindly attach a complete discharge summary.

2) Kindly attach the report of the allergy prick test. And also, let me know the allergens, including food allergens and aeroallergens like dust mites, various other dust, pollens, fungi, animal dander, etc. If you have not yet tested, then kindly do the test and attach the reports.

3) Please let me know the blood levels of vitamin D3, vitamin B12, thyroid function test, and blood sugar.

4) Do you have any additional medical conditions like diabetes, blood pressure, or any form of immunosuppression?

5) The theory of food particles going up into the nose and the sinuses are a little far-fetched. But acid reflux can produce symptoms similar to that. In rare cases, acid reflux is known to cause such issues. Do you have any other reflux-related symptoms?

6) Do you smoke, use vape, or any inhalant drugs?

7) Have you done any CT (computed tomography) scan or nasal endoscopy after the surgery?

Please provide details for all these to help you better.

Thanks.

Hi doctor,

Thanks for the reply.

1) The surgery I had was to fix a deviated septum. I had a crooked nose, so the ENT specialist opened up my airways in the nose. The surgery was done two years ago.

2) I do not have a discharge summary.

3) I did an allergy prick test a couple of years ago. It just showed grass, birch tree, alder, and some mold. I would like to know what type of tests can be done to figure out allergies?

3) I have never had diabetes, blood pressure, and any other immune disorders.

4) I will do the tests mentioned above and attach the reports.

5) I never had heartburn. I have had some bloating and stomach discomfort, which I have been trying to cure by eliminating all dairy products, gluten, and sugar. I take probiotics and have been attempting to be healthy.

6) I think that the airborne allergy is the cause of my issues, but I have no idea how to test or what to look for.

7) I did a CT scan four months ago, and my ENT said my nasal passage looked good. He did mention that he saw a small benign cyst.

Kindly help.

#

Hi,

Welcome back to icliniq.com.

1) The septal correction surgery improves the airway but does not do anything much to the sinuses. Hence we need to do an endoscopic sinus surgery.

2) Regarding the allergy prick test you have done already, why did they not suggest immunotherapy? Here, if you are tested positive for an allergy test and if it correlates with the symptoms and clinical findings, it is advisable to start on allergy vaccines. They are otherwise known as allergen immunotherapy.

3) Need not repeat the skin allergy test if the initial one was done at a good laboratory. However, if the initial one failed to show any positives allergens, I suggest you do a blood immunoCAP test. Usually, the skin prick test is better and more efficient than the blood allergy test.

4) A nasal endoscopy will rule out any polyp or mass inside the nasal cavity. If the endoscopy is not satisfactory, kindly do a CT (computed tomography) scan of the nose and sinuses.

5) In addition to the blood tests for allergies which would include the immunoCAP test, it is advisable to do serum immunoglobulins test, total white blood cell count, differential white blood cells count, thyroid function test, vitamin D3, vitamin B12, fasting and postprandial blood sugars, and HbA1C (glycated hemoglobin).

6) The flaring of symptoms at night need not necessarily be due to reflux alone. It could be due to indoor allergens like dust mites or molds. You can try taking an antacid for a week and see if this particular symptom improves.

However, if you can provide the CT scan films and blood reports, I would suggest more measures that can help relieve your symptoms.

There is a new drug called Dupixent (Dupilumab). It is usually given to patients with nasal polyps. Although the use of Dupixent is not yet approved officially against nasal allergies, we have given it to a few patients, and they have got an excellent relief. But that can be done only after a nasal endoscopy, CT scan, and if the immunotherapy fails.

Take care.


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