Help Me to Breathe Easier

December 9, 2007 10:59 AM

Sinus Filter: I've had "nose" issues since I was a kid, but the situation is getting worse. (long story inside)

As a child, I got nosebleeds often; had my nose cauterized twice, had one that was so bad and prolonged that I ended up in the ER and subsequently on bed rest (with a packed nose) for two days. (What really bugged me about that particular experience was the ER doctor telling me as he put gauze up my nose that he saw "fingernail marks," implying that it was because I'd been picking my nose that this had happened. Not true at all, but who listens to a third-grader at three in the morning?)

Anyway, as time went on I was progressively more "stuffy" and (to my mind) my voice became increasingly nasal due to nose stuffiness. I finally went to an ENT doctor in 1978, and he proceeded to put me in what looked like a dentist's chair and then tilted it so that my head was below the rest of me, and an assistant squirted water up each nostril continuously, while instructing me to repeat "K K K K" the entire time. Well, I can't tolerate water up my nose. I don't swim, I stand backwards in the shower. So I felt like I was drowning and they stopped the procedure midway through. The doctor seemed put off and told me I had a deviated septum and sinusitis and wrote me a prescription for Sudafed (it wasn't over the counter at the time) with 10 refills.

Fast forward many years, and I am dx'd with Lupus and several associated illnesses, including Sjogren's Syndrome, which causes dryness of the mucous membranes. Usually it mainly affects the eyes and mouth, but mine is strictly concentrated in the nose. In fact, I often seem to have too much saliva, as I'll drool in my sleep, even when I'm laying on my back (the outpour of saliva will actually wake me up). I'm still stuffed up most of the time, and I know I've got at least some congestion in my sinuses because I can feel the facial pressure move from side to side when I roll over in bed. I also occasionally have hours at a time when I experience "weird" smells - one is siimilar to burning plastic, the other smells like calomine lotion. Several spritzes of Ocean nasal spray seems to help a little, but that's about as far as I can go when it comes to water up the nose (so a Neti pot is out of the question). One other "symptom" I've noticed is that if I cry, 20 or so minutes later I will become so stuffed up that I have to breathe through my mouth, and it takes many hours for that effect to subside.

So...I know I need to see another doctor, but is he/she going to irrigate my nose again? Do you think there is any significance to the crying/nasal congestion thing? What about the excess saliva but nose so dry that it feels stiff on my face? And the strange smells....? Please reassure me that a visit to the ENT doesn't have to be traumatic, and guide me as to what questions I should ask/which symptoms of mine are significant.

posted by Oriole Adams to health & fitness (10 comments total)

In my convoluted sinus history, the weird smells have always turned out to be an infection, just as an aside.

Earlier this year, I went to an ENT for the same constant sinus pressure, can't breathe out of my nose-ness, and once diagnosed with a deviated septum, was scheduled for a septoplasty. I spent one outpatient day at the hospital, and about 6 weeks recovering, but when it was all done, I could breathe. It was glorious.

At no time did the doctor irrigate my nose, though I had to rinse it with saline after the surgery to keep the tissue from drying out- just in the front, the same essential place you'd reach by rubbing the inside of your nostrils with tissue. Even in the preliminary and post-op visits, there was no irrigation in the office. The ENT sprayed a tiny bit of decongestant in my nose to get a good look up there, but that was all.

Go see your doctor. Times have changed!
posted by headspace at 11:17 AM on December 9, 2007 [1 favorite has favorites]

ENT--that's their specialty. Don't worry, go! They may numb you before they look--just a spray, nothing big. Tell the doc about your previous experiences, and if they are any good they will explain what they are doing and try to make it a positive experience. Times have changed!

I'm not sure about the water irrigation, are you sure it wasn't saline? They sure wouldn't do it with your head tilted backwards--very odd.
posted by 6:1 at 11:47 AM on December 9, 2007

You might try using a neti pot. Yes, it involves putting water up your nose. Actually, it's pouring saline into one nostril, with your head tilted forward (not backward!) and sideways, so that the water drains thru the nasal cavity and out the other nostril. It removes a lot of extra mucus and other junk along the way. Apparently this has been a part of Indian medicine and hygiene for centuries.

I first tried it a couple months ago. I don't do it frequently, but it has helped me when I've had a lot of head congestion. My wife does it almost every day, and she says it has made a tremendous difference, virtually eliminating her post-nasal drip.

It's a very gentle procedure. I don't like the idea of water up my nose any more than anyone else does -- we all tend to associate it with drowning, I think -- but as long as you just continue to breath steadily thru your mouth during the minute or two that it takes to empty the pot into your nostril, and don't inhale thru your nose, it's a cinch. Done properly, it is, at worst, very mildly uncomfortable (there is a temporary sense of somewhat increased pressure in your nasal cavity while you're doing it), but I would suggest it's probably a lot less unpleasant than what you're currently suffering thru. And the relief it would bring you afterward could be significant.

Just make sure the saline solution is not too cold or hot, and that it's mixed in the proper proportion. You can order a plastic neti pot and packets of saline mix on Amazon.
posted by Artifice_Eternity at 12:42 PM on December 9, 2007

The neti pot was savior for me. But yeah, you really do have to get used to the whole water in nose thing. The good is that if you do it properly it should feel soothing. Even Walgreens (!!!) sells a plastic one with pre-measured packets of salt, so you don't get problems due to improper amount of salt. And what a relief afterwards.

Otherwise, I'd suggest a humidifier and proper air filters. Those also make a huge difference for me.
posted by melissam at 12:51 PM on December 9, 2007

Medicine has changed a bunch in 30 years. Circa-1978 medicine is not a fair comparison.

That being said, you have lupus and srojen's, two incredibly complex and concerning diseases that can affect every body system, including the mucus membranes. All of your questions are completely appropriate to be asking your rheumatologist or your internist (since you'll probably need a referral to ENT), but honestly, not strangers on the internet. You don't necessarily have run-of-the-mill nose issues that someone can answer with their N=1 experience. You have lupus and srojen's, you're possibly on a number of medications, and you have nose issues. Not the same.

Write down your questions for your ENT visit. No one here knows if the ENT will want to irrigate your nose again, only the ENT that sees you that day, but rest assured he or she is not going to forcefully make you do anything. It might make the diagnosis more challenging (or impossible, I have no idea, not an ENT), but if you don't want it done, or have questions about it, speak up. If you "can't tolerate water up your nose," and the ENT wants to irrigate your nose, you have a decision to make: which is worse, the complaint you're seeing the ENT for, or the water up the nose? Your choice.

I am not a doctor, I am not your doctor, you are not my patient. This is not medical advice, just an opinion.
posted by gramcracker at 1:45 PM on December 9, 2007

If you go to the ENT, and it does turn out that they want to irrigate your nose, you could ask for some light sedation. I'm not sure that they'd give it to you, but I know dentists sometimes do this for anxious patients. Just make it clear that you really don't like having water up your nose.
posted by ArgentCorvid at 2:46 PM on December 9, 2007

The first thing I thought when I was going through your question was "neti pot." My husband was really, really skeptical and was very adamant that putting water in his face was Bad. . . But he will do the neti pot thing now. It's very weird, but I do encourage you to try it, even if you are a little freaked out by it. It will not only flush out whatever is hanging around in your face, but it will also moisturize your nasal passages. The idea behind the saline solution, or so I've read, is that the salinity and temperature should be about the same as human blood, so your body doesn't freak out and start trying to use osmosis to get the salt in or out (which is, apparently, why it hurts to get plain water up your nose).

Whether or not you can bring yourself to use a neti pot, definitely visit a new ENT. Good luck. My husband has very terrible dust and pollen allergies, and while it's not quite what you are up against, it's still pretty awful sometimes - having your face, head, and probably neck constantly hurting is pretty awful.
posted by Medieval Maven at 4:24 PM on December 9, 2007

You need to ask your rheumatologist for a referral to an ENT who they've worked with in the past. Some ENTs will be better at dealing with your condition than others.

I have never had a painful experience at an ENT, and hopefully the referral will make it easier for you to find a great ENT you can keep seeing until you get your problem fixed.
posted by sondrialiac at 6:11 PM on December 9, 2007

I find that watching my breathing for 10-15 minutes and making sure that I don't breathe through my mouth at all during that time causes my sinuses to clear. This ties in with the notion that mouth breathing stimulates mucus production, although I'm not sure how conventional that idea is. Anyway it's pretty safe and easy to try.

My congestion issues have also improved hugely with the daily use of Beconase.

[Sorry if these answers veer too far away from the actual questions!]
posted by teleskiving at 3:37 PM on December 10, 2007

I wanted to second what headspace said. Last December, I had surgery to resculpt my highly deviated septum and shave down some structures in my sinuses, and while the recovery period was kinda rough, the past year has been glorious. I have more airflow through my nose than I ever have, and my allergy symptoms have seriously alleviated. GO see a good ENT(get a referral from your PCP) and give it a shot!
posted by daveqat at 5:04 PM on December 10, 2007