My super power would be the death sneeze.
September 7, 2011 8:39 AM   Subscribe

What's the best way to go about fixing my sinus/allergy/sneezing problems (including establishing a case history for surgery)?

Ok, so, these details may be a bit much for people but I'm going to go ahead and put it all out there. Feel free to skip around and just post your experiences but I figure more info is better than less.

Situation: I've always been plagued by sinus problems. Be it seasonal allergies, sensitivity to specific allergens (dust and cast are probably the most prominent), wheezing breathing that comes and goes, snoring at night, nasal passages that feel 'stuffy' more often than they feel clear, nasal passages that are clogged often, daily 'bad taste' in my mouth when I wake up, and... stinky sneezes. I'm a 20s-30s male, never smoked, non-drug user who is, admittedly, a bit overweight (darn this desk job!) but has never been 'skinny' or morbidly obese either.

Background: Both my parents smoked (indoors and in vehicles) when I was growing up. There was also a bit of a dust problem in the house. I had tubes in my ears at a young age. I've had these problems as long as I can remember.

Current treatment: Zyrtec during the workday when needed, Benadryl at night if things are miserable, a neti-pot when I remember to do it, and avoidance of dust/cats/pollen where possible. Also, I'm not great about brushing my teeth as much as I should but even in the past when I've been super diligent with brushing/mouthwash I saw no improvement with the morning mouth/sneeze situation.

Recent developments:
I have always tended to fall into the 'I'm tough enough to deal with this without intervention" camp. In many ways I still am I suppose. But I guess I reached a tipping point recently when I was riding in the backseat of a car with my fiance and another couple driving. I sneezed and my friend's reaction of "Man, what's that smell?" really drove things home and made me feel pretty bad/embarrassed. My fiance has always noticed this and has mentioned it to me in the past but I always chalked it up to her being super sensitive since my sense of smell has never been close to what, I'm sure, other people possess and she does tend to notice minutia like that at times....

Anyway, if anyone could tell me what's going on, if it's too late for allergy shots (probably is, from my understanding), if some type of surgery (polyp removal, flushing, etc etc) sounds like an option or has helped you in the past, as well as what the costs of such things might be (with or without insurance). I have insurance coverage through my work at the moment in the form of a Health Savings account but will probably be going back to a more traditional co-pay type system in the near future when the marriage allows us to change plans.

Thanks for the advice/help/blah blah.
posted by RolandOfEld to Health & Fitness (18 answers total)
It is not too late for allergy shots. I was much older than you when I got them and they helped me quite a bit. Get a referral to an allergist and get tested and go from there. You've tried to treat this yourself and now it is time to go to a professional.
posted by gudrun at 9:01 AM on September 7, 2011

i think before you get to surgery, you need to start a constant routine.

i have horrible allergies. sneezing, choking, wheezing, eyes watering, face puffy grossness. i have asthma that is made amazingly worse by my allergies. i'm allergic to the inside, the outside, plants and animals. i tried to treat them "when they got bad" and i ended up with year after year of bronchitis and entire weeks lost to allergy attacks. i lost most of my sense of smell for months at a time. finally i gave in and went to the doctor.

now i'm on flonase (2 sprays per nostril per day), flovent (2 sprays, twice daily), and a daily zyrtec no matter how i'm feeling.

my bad allergy days are much, much less often (once every couple months, usually from skipping some of my medicine). i barely ever use my rescue inhaler anymore.

i'm hoping that come winter i can reduce some of the medicine (i get a little more spacey these days), but i can't believe how different my life is without constant allergy attacks.
posted by nadawi at 9:08 AM on September 7, 2011 [2 favorites]

Allergy shots do work, but are quite a committment. I couldn't stick with mine because we moved often, but for the year I did them, it was 3 shots 3 times a week. And my understanding is that you have to do them for 3 years in order for them to have any beneficial effect.

I had endoscopic sinus surgery in January, and I don't think I would do it again. I have not noticed enough of a difference to make it have been worth it. Others have had different experiences, but I have noticed minimal improvement, if any. I've had at least 11 sinus infections since the surgery.

My advice: keep up with the neti pot. I know it sucks, but dude, it works. At least once a day every day. It not only keeps things unclogged, but it rinses out the allergens that do the clogging. If you don't get any improvement after 6 months of using the neti pot, I would go see an ENT and get a CT scan, if only to make sure that there aren't any anatomical reasons that this could be happening, such as a deviated septum.

Parenthetically, I've tried something new in the last week that has helped me a LOT...Mucinex makes a sinus product now that thins the sinus mucus and helps it to drain appropriately. Get the stuff with the pseudoephedrine if you can...phenylephrine is useless.
posted by altopower at 9:12 AM on September 7, 2011

Have you visited an ENT recently? My father just got his sinuses rotorooted again because of sinus infections and polyps...but I've never heard of allergies causing stinky breath. That seems like a strange enough symptom that it's totally reasonable for you to schedule a visit (and for your GP to refer you, if necessary. )
posted by leahwrenn at 9:15 AM on September 7, 2011 [1 favorite]

A prescription nose spray will probably help a lot. Also, consider using a non-drowsy antihistamine/allergy pill, every day, not waiting for problems to occur.

Preventing the inflammation should be the goal, not allowing to start and then trying to get rid of it.

I use Allegra daily and a Neti Pot after being out with a lot of grasses and pollens. Usually that's enough, but when it gets bad, I use the nasal steroids and other stuff prescribed to reduce the inflammation.

Best bet is visiting an ENT doctor. Professional advice has helped me.

Good luck. I hope you get through this.
posted by Argyle at 9:22 AM on September 7, 2011 [1 favorite]

It's never too late for allergy intervention. You should get yourself seen by an allergist/ENT and get tested first to see what all of your triggers are. Once you know that, you can start a course of treatment. Shots aren't the only answer, either. There are sub-lingual drops now and you may even find that you don't need much more than daily medication. Zyrtec might not be the one for you. I had to try out three different ones before we found the one I'm currently on (plus a nasal spray and Advair for my asthma). And yes, keep using the Neti pot.

You mention the smell thing...could you possibly have tonsil stones? If your nose is too stuffy to breathe through at night, you're probably breathing through your mouth and that can cause serious tonsiliths. Dealing with those might make the bad breath less of an issue.

As for sinus surgery, my mother had it done a few months ago and it was brutal. Granted, she's much older than you, but still: it's nothing to be done lightly. You really ought to investigate everything else at your disposal first.
posted by cooker girl at 9:29 AM on September 7, 2011 [1 favorite]

Neti pot made my problems WORSE and I used to be a big advocate of them. I kept picking up infections every 6 weeks. It was awful. Now as long as I use Nasonex every day like I'm supposed to, and a daily antihistamine (usually Allegra etc) I can be ok between infections and colds for longer periods. Definitely try a prescription.

Earlier this year I also realised how much stress impacted my sinusitis, so I do yoga and run now and then. Also, try to drink lots of water!
posted by wingless_angel at 9:37 AM on September 7, 2011

My experience is that if you go to an ENT, they will think about these issues:

tooth, dental, jaw infection
GERD/acid reflux
sinus infection
other infection
blockages due to inflammation/irritation, such as polyps
physical deformities/abnormalities

From what I've been told, only the last needs to be treated with surgery. The other issues, including polyps, can be treated by any number of things that are less invasive and less risky. I successfully got rid of polyps with Nasonex, which I only took for a few months. Got rid of constant sinus/ear/throat pain by treating reflux in various ways.

I had surgery as a teenager and, although it was a well-done surgery, you really want to avoid it if possible.
posted by the young rope-rider at 9:57 AM on September 7, 2011

Response by poster: Thanks for the info, few responses to things that jumped out at me:

I'm not afraid of the allergy shots except when it comes to the expense. Shots don't bother me at all. I just don't want to waste time/money/effort. I guess it's to that point now.

I was on the steroid based sniff-sprays when I was younger (sorry, forgot to mention that) and they did seem to open things up a good bit, however, I seem to remember developing a dislike for the way they made me feel. But that could just be projecting my feelings of guilt for the monetary impact they had on my family at the time. Zyrtec is the best I've been able to manage as far as over the counter meds that balance function, alertness, and not making my sinus discomfort different (aka dry, hard, etc) instead of 'better'. Trust me, I've tried plenty of brands/types as I'm sure most people in my situation have.

I hesitate to take a pill daily to keep symptoms down, even if it is 'non-drowsy', because frankly they all make me feel like crap, just to a greater or lesser degree. I'm pretty resilient to medicine's side effects when it comes to most types, but man, something about allergy/sinus meds really kick my butt. Not to mention that becoming a constant drain on the pocketbook, which really gets to me in more ways than one.

I've not seen a ENT in years. I've just been sucking it up. I think it's to that point as well. I'm surprised to hear the bad things about surgery. But then again my family's sample size (a distant uncle) who had a very successful polyp surgery is rather small. That'll have to wait until the wedding though.

Tonsil stones... hrm...................

Oh, and I do drink more water than the average bear. It helps, I know.
posted by RolandOfEld at 10:10 AM on September 7, 2011

You may find that with daily use, the side effects will diminish. I know that when allergy season ramps up and I start taking Benedryl in addition to everything else, it only takes a few days of constant use to stop making me drowsy.
posted by crankylex at 10:24 AM on September 7, 2011

I know I said this above and not to harp on it, but really, the right medication won't kick your butt and it will work. Over-the-counter just doesn't cut it for some people and you might be one of them. It sounds like (from what you've described) that you might be taking things with decongestants in them (and for sure you are when you take Benadryl). That's what's kicking your butt, even if it says non-drowsy on the label.

It seems to me (and I'm not anyone's doctor, just a lifelong allergy sufferer - until I found the right combination of meds + sub-lingual drops) that you're treating the symptoms rather than the cause and things won't get better until you treat the cause. Find out, with the help of an allergist/ENT what your triggers are and then you can target them with shots/drops/meds. The sub-lingual drops are FAR less expensive than the shots, mostly because you can administer them at home, which cuts out the office call fee. I have an HSA, too, and trust me, the drops are not the drain on funds that the shots are.
posted by cooker girl at 10:43 AM on September 7, 2011

I was diagnosed with Non-specific Allergic Rhinitis, which is an ENT's way of saying my nose runs a lot but they're not sure exactly why. I use prescription Astepro and Flonase each day along with an OTC antihistamine (Loratadine - some brand names: Alavert, Claritin). I thought about going to an allergist and finding exactly what I'm reacting to but the treatment works well enough that I've put that off for now.

But I'd be more concerned about the odor issue, that says to me there's a possibility of a chronic infection at work here. An ENT will be able to discover what's going on but make sure you fully discuss any suggestions for surgery. My ENT mentioned that my left nasal passage was narrow and recommended surgery on my septum. While my left side does tend to get blocked more readily than my right, I didn't think surgery was right for me. Never hesitate to get a second opinion.
posted by tommasz at 10:45 AM on September 7, 2011

i agree with the others here, taking the allergy medicine daily really reduces the side effects. i have the same problem as you when i just take zyrtec sparingly, "as i need it." when i went to daily, it's just a little bit of spacey, but totally manageable. not at all like it was when i took it occasionally.

before flonase, i was taking a zyrtec-D 2 or 3 times a week. they screwed with my sleep, dried my face out, made my IBS-C way worse, and i just felt foggy for a couple days. now that i'm on flonase i think i've taken 2 zyrtec-d pills. it's been about a year, i think. and with insurance it's stupid cheap. it took me a couple weeks to get used to and i thought i'd hate the drainage/taste forever, but now that i have things managed, i don't have that problem anymore.

your allergies will never feel better if you wait until you're sneezing to treat them. preventing the freak-out from starting is the only method i've found.

the added bonus of flonase/flovent - you're required to rinse your mouth out afterward, so i remember a lot more often to brush my teeth.
posted by nadawi at 11:12 AM on September 7, 2011

Sort of like you, I get stuck sneezing & sinusing to the point of exhaustion sometimes. I agree it'd be good to check with an ENT to make sure you dont have tonsil stones, start on a flonase regimen, but don't get rushed into nose surgery thinking it will be some quick fix, it was a huge hassle for me and was not worth it at all.
posted by yeahyeahyeahwhoo at 11:29 AM on September 7, 2011

My experience.
Chronic allergic rhinitis for years.
colds lingering for months.
sinus infections.
burst ear drum.
more frequent chest congestion.
here's the medical steps i took in the order i figured them out.
some antihistamines or decongestants (up to age 23)
starting at age 23
flonase daily effective
anithistamine daily effective
allergy shots effective
stops these about age 28
age 36
nasal surgery which correct my septum which block both left and right sinuses. effective
removed nasal polyps. effective.
began using the nasal rinse, not a neti pot. very effective
age 48 currently
considering seeing an ENT again because my ability to smell/breath through nose is minimal most of the time.
So, if I had to do it over again, at age 6 I would have started the nasal rinse and daily anti-histamine. Also, began the allergy shots and steroids as soon as possible. then later in adulthood would have looked into the surgery.
posted by swmobill at 2:43 PM on September 7, 2011

I don't know anyone who's had sinus surgery for allergies who would recommend it. Reactions range from "meh" (polyps grew back within a year or two) to "HOLY SHIT STAY AWAY FROM THOSE FUCKERS" (loss of smell, constant feeling of suffocation from empty nose syndrome.)

It sounds to me like you've got some serious postnasal drip and perhaps a chronic sinus infection, based on personal experience with same? And I'll note that since my sinus infection was largely in my upper sinuses, I often didn't feel stuffy/congested. I got used to the chronic headaches, I had some evil postnasal drip, and I was utterly exhausted, though. It took some serious antibiotics to get me over the sinus infection, and since them I'm just very careful to avoid another, and have quarterly checkups with an allergy/asthma practice.

I got a lot better about using a netipot (well, I use the NeilMed bottle now) once it occurred to me to use it in the shower. It's worth revisiting the steroid nasal sprays, too. Works so much better for me than any of the prescription antihistamines. I take a lot fewer medications than I did before, and I can breathe!
posted by desuetude at 9:50 PM on September 7, 2011

heat is another anti-histamine, so I find a cup of hot water to sip (even to press the mug to my face) is good to kill the reaction, massaging my face with this massage technique (previously) helps shift the mucous.

I took half a zyrtec every day for a year (at least!) and it sucked. Made me fall asleep on the bus all the time which was creepy. When I took the occasional tablets (different brand, zyrtec unavailable for some reason) they caused me to have suicidal thoughts, which is not fun. I'm very anti allergy drugs for this reason.

But the smell- that's not something I have experienced. I would check that out with a doctor, maybe it's a deep infection that needs treated.
posted by titanium_geek at 6:50 AM on September 8, 2011

I have allergy troubles that have gotten worse as I've aged. I use Nasonex nasal spray to relieve allergy symptoms. I use facial massage to relieve pain and help with gunk drainage. I use gently-heated microwaveable hot packs to relieve pain. I've also undergone sinus surgeries 2x for deviated septum issues. First one didn't seem to help; second one definitely did. That said, the pain of having the packing removed each time was blinding, as in almost worse than bearing my child into the world. It's really really painful. Try to avoid the surgery route.

You say you use the Neti pot only sporadically which surprises me a little because you also indicate costs are an issue. You already have the pot; add water + salt. How much cheaper can it get?

Maybe you could try to change that to "at least once daily" for two weeks, just to see if regular use makes a difference? To get into the habit, pick a time of day that makes sense with your routine, set your supplies out where you know you'll see them, then do it. For me, it's first thing in the morning when I've made coffee and I got nothin' else to do while the coffee steeps in the press pot. For infection prevention it's also very important to keep the pot clean and dry between uses.

Possibly related to nasal/breathing troubles: you also might consider asking your beloved if s/he notices what your sleep-breathing is like. Sleep apnea could be another possible explanation for the snoring and congestion. As soon as you can swing it, make an appointment with an ENT. They're the ones with all the cool tools that can ultimately help diagnose and treat your trouble.
Good luck!
posted by mcbeth at 9:01 AM on September 8, 2011

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