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December 18, 2010 8:52 PM   Subscribe

ENT Filter: Should I be concerned about not being able to sneeze? (I know YANMD!)

I've been seeing an ENT since May because of fluid build-up in my ear (I have earlier posts dealing with thinking I had earwax build-up). I had to get a tube in one ear (originally it was going to be both ears, but one drained right before surgery). I've been satisfied with my tubed ear, but since surgery, I'm beginning to experience fluid in the non-tubed ear again.

Okay, that was just some quick background info. I just wanted to point out that I'm having some kind of.. clogging in my ENT system.. possibly a malfunction of my eustachian tube. My question here is really about not being able to sneeze. I have had year-round allergies since I was a kid, and allergies and colds were always filled with a lot of sneezes. It occurred to me that I haven't had one sneeze now in over a year. I experience internal allergies (that kind of stay in my head for about 24 hours and then I'm better), and, right now I have a head cold (and, I swear I ALMOST felt like I was going to get a sneeze, but then it petered out). So, I often feel as if I NEED to sneeze, and I can't manage it. I've googled different methods to induce sneezing and nothing's worked so far. I have told my doctor about this, and he didn't seem to think it was a big issue. He's always in a huge rush and doesn't ever want to take the time to answer my questions, but I've brought this worry up every time, and he always says that it's nothing to be concerned about. The doctor did look up my nose (not with an instrument, he used something to pull up my nostril and looked in).*

Is it possible to 'forget' how to sneeze? Could this be indicative of a bigger problem? I'm wondering if my inability to sneeze could be related to the clogging of my ENT system and is encouraging the fluid build-up in my ears (my doctor thought no). I'm wondering if I could sneeze, if that would open up whatever is clogged (sinuses, etc.) and if that would start the natural draining process. I would really love to sneeze right now with this cold to get some of the gunk out of my head..

*To some extent, I think my doctor is not taking my concern seriously because I have no insurance (and I'm not employed/on a budget), and he doesn't want to go through expensive testing that would tell if there's a bigger problem. There really isn't another nearby doctor who could give me a second opinion.

Thanks in advance for any insights/answers!
posted by Mael Oui to Health & Fitness (11 answers total) 2 users marked this as a favorite
Response by poster: Oh, I don't know if it's important, but with the cold and allergies, my nose does run.. so maybe that means that there's not as much of a major nasal clog as I'm thinking there might be.. I don't know, I just thought I'd throw that out there, too!
posted by Mael Oui at 8:54 PM on December 18, 2010

Sneezing is a reflex. You can't really control it, much like you can't control the knee-jerk response. Brain trauma can disorder a reflex (such as swallowing, for example), but I very strongly doubt that's what's keeping you from sneezing. Are you on any antihistamine allergy medicines? I remember histamines being involved in triggering a sneeze.
posted by Nomyte at 9:04 PM on December 18, 2010

"I'm wondering if I could sneeze, if that would open up whatever is clogged (sinuses, etc.) and if that would start the natural draining process. I would really love to sneeze right now with this cold to get some of the gunk out of my head.."

Sneezing clears your nose (or doesn't, I guess, if your nose is very stuffed), not your sinuses or anything else. In fact, in my experience, sneezing with fully-gunked-up sinuses HURTS LIKE A MOFO from the violent, uncontrollable head motion. And doesn't help a thing, you just have a worse headache afterwards.
posted by Eyebrows McGee at 9:52 PM on December 18, 2010

Response by poster: I used to take Benedryl* when I had allergies, but I stopped taking all allergy-related medications after I stopped having allergies that produced phlegm and stopped sneezing. So, no antihistamines for.. over a year, I would estimate. I guess my concern is: I used to sneeze a lot, and now it seems like I can't even though I really, really feel like I need to.. And, at the same time, this problem is coinciding with a fluid in the ear problem that is severe enough as to require surgery (and has temporary muffled hearing loss as a symptom).

I don't think I have brain trauma.. I mean, I haven't bumped my head or had any sort of accident, if that's what you mean by brain trauma.

My nose is what's gunked up. I have had an increase in sinus headaches with this whole ENT situation, but that's improved since I got the one tube. Otherwise, I never really had sinus problems before, and I don't know for certain that sinuses are the problem. There's some minor pressure there since I have a cold now, but it's not painful or anything.

*I'm going to admit, I used to take Benedryl preventatively in the summer because I would have such frequent allergies. I would also take it to put myself to sleep if I was having problems sleeping. So, I've often wondered if I took it too much. I mean, I would take one pill per day (on the days when I took it). Dosage-wise, I don't think I overdid it, but I wonder if somehow that did something..?
posted by Mael Oui at 10:28 PM on December 18, 2010

Well, you do feel the urge to sneeze, which is the histamine component of the sneeze. So it's probably not your Benadryl.

The rest of the sneeze is a brain stem response. It would be remarkably weird if something was going on in your brain stem, and the only thing that was affected was your ability to sneeze. The brain stem controls a lot of very important things, and sneezing is way down on the list.

In your place, I would focus on the fluid build-up and the rest of the pressing health issues. If that resolves the sneezing conundrum, excellent. If not, be on the lookout for any other peculiarities and present them to your doctor.
posted by Nomyte at 10:41 PM on December 18, 2010

I think you're absolutely right to be concerned.

The fifth cranial nerve, called the trigeminal nerve, is apparently responsible for sneezes.[citation needed]

Cranial nerves can become compressed and cause serious problems (compression of the seventh nerve causes Bell's palsy, for example).

I think the fact that your sneeze reflex no longer works is an indication your trigeminal nerve is not functioning as well as it should, possibly as a result of minor compression from all the swelling in your ears and sinuses.

Maybe it's time to find a doctor who is willing to look into this a little more thoroughly.
posted by jamjam at 11:15 PM on December 18, 2010

If CNV (trigeminal) was dysfunctional, the OP would have far more obvious issues than not being able to sneeze. Loss of, say, significant facial sensation (various zones depending on the impingement), or mild trouble opening the mouth, chewing, or loss of sensation inside the mouth. It's also a bilateral structure, and with an irritant at least one side will usually tell the brainstem to sneeze.
posted by Uniformitarianism Now! at 5:30 AM on December 19, 2010

As the Wikipedia article on trigeminal neuralgia points out, true rates of the condition are uncertain because it's significantly under-diagnosed.

In Mael Oui's case, there is a smorgasbord of symptoms to choose from, but it sounds as if they've never been evaluated with trigeminal neuropathy in mind, so I don't think we can be confident he doesn't have any of those other 'issues'.

But even if that weren't true, instances of idiopathic trigeminal neuropathy and especially instances of atypical trigeminal neuralgia seem to show that trigeminal nerve problems can be extremely various and unpredictable, quite limited in scope, and need not progress.

My thought was that trigeminal neuropathy would produce an inability to sneeze not from cutting the wires on both sides, but as an adaptation to prevent trigeminal problems from getting worse because of sneezing.

After all, sneezing can be pretty violent (as Eyebrows McGee says) and there are anecdotal accounts out there of sneezing activating trigeminal pain, such as this one from a forum dedicated to sufferers of trigeminal neuralgia:

Jul 7, 2010 ... Today I sneezed once and pain was unbearable. Has anyone else had pain from sneezing?
posted by jamjam at 1:20 PM on December 19, 2010

Response by poster: Hmm.. that's very interesting about the brain stem/neural information. Obviously, I don't know anything about that area of anatomy (I don't really know ANYTHING except what I've picked up reading about my health issues). So, that's why I asked the question: to determine if there's something more serious (or, not necessarily more serious.. treatment ideas would be welcome). I was really thinking more about nasal polyps or something like that blocking up an opening and preventing sneezing and/or the natural draining of the ears rather than something neurological. Not that I have any reason to suspect that that is the cause. And I don't know if that would be something that could be seen without a special instrument. My doctor has peeked up the nostril and hasn't seen anything, and.. maybe there's no connection between a hypothetical growth of that sort and a blockage that would cause fluid build-up or inability to sneeze. I haven't had any other recent changes healthwise, and I definitely don't have any loss of sensation or trouble doing anything that's voluntary (as opposed to involuntary sneezing). The ear issues.. I've had ENT issues off and on since I was a kid. So, while I don't want to ignore that and let it become a bigger issue, it wasn't exactly a shock that I was having this problem with the ears. I guess I'm afraid of what the root cause of the fluid build-up is.. Every time I had that before, it was able to fix itself after a period of time, and I never needed to get tubes in. I'm worried that tubing the ear hasn't actually solved the problem, just that it's a temporary fix and that there's something more serious I should be considering.. Anyway, thank you for your responses so far! I'm going to read up on some of the neurological issues that you've raised now!
posted by Mael Oui at 7:46 PM on December 19, 2010

Mael Oui, if you haven't already, please check your MeMail. :) Take care.
posted by Uniformitarianism Now! at 7:21 AM on December 20, 2010

Response by poster: Gotcha! :-D
posted by Mael Oui at 11:49 PM on December 20, 2010

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