With A Deviated Septum, Why Does Nasal Obstruction Come and Go?

A deviated septum is a well known factor causing nasal obstruction in people. However, many patients with a deviated septum will also state that there are times when they can breath just fine from their nose. As such, can a deviated septum truly be the cause of their nasal obstructive symptoms? Shouldn’t the obstruction be constant?

The blunt answer is ABSOLUTELY nasal obstruction can be intermittent OR constant with a deviated septum!!! It’s more a question of degree.

To begin with, a deviated septum is when the wall that separates the right and left nasal cavities is bent one way (green arrow) instead of being perfectly straight.

If there is no mucosal swelling, a person with a deviated septum is able to breath from both sides just fine. However, if there is the slightest bit of mucosal swelling from turbinate hypertrophy, allergies, upper respiratory infection, or any other environmental irritation, the side that is more narrow will obstruct much more readily with less swelling given there is just “less room” for swelling to occur before obstruction occurs.

Below is the same exact nose and septum as above, but with mucosal swelling present.

As you can see, with the same exact amount of swelling present, the deviated septum significantly influences how much space is present for air to pass through compared with a straight septum.

As such, even though a deviated septum may not technically be obstructive, given there is less room for any swelling to be accomodated, a patient will complain of nasal congestion and obstruction much more readily compared to someone with a straight septum due to the slightest changes in mucosal swelling.

How is a deviated septum fixed? Click here to read more.

Of course, one can try and control the mucosal swelling to avoid any surgical intervention, typically with steroid or anti-histamine nasal sprays. The downside is that such medications need to be used daily to prevent swelling from occurring in the first place.

Novel Treatment for Non-Allergic Rhinits

Non-allergic rhinitis is an extremely frustrating sino-nasal disorder that is characterized by all the same symptoms of sinusitis and allergies, but NOT due to sinusitis or allergies. Rather, I consider non-allergic rhinitis to be the over-sensitive nose syndrome whereby breathing in air containing particulates (whether smoke, perfume, dust, pollen, etc) PHYSICALLY irritates the nose causing symptoms.

This is in contrast to allergies where the pollen causes an immunologic reaction causing symptoms or sinusitis which is due to an infection.

Non-allergic rhinitis is diagnosed by a negative allergy test (meaning symptoms are not due to allergies) and normal CT sinus scan (meaning symptoms are not due to a sinus infection).

Usually, treatment encompasses avoiding triggers (ie, perfume, smoke, dust, etc), applying a barrier nasal emollient (ie, ponaris), anti-histamine nasal spray (ie, astelin, astepro, patanase), and nasal hygiene using saline flushes which washes away the irritants causing symptoms.

Well, a new study published this month have shown another mode of treatment is quite helpful… ICX72, a proprietary homeopathic preparation of Capsicum annum and Eucalyptol, otherwise known as Sinus Buster!

When used twice daily over two weeks, symptoms were found to be significantly improved when compared to placebo. Furthermore, sinus buster alleviates symptoms attributable to non-allergic rhinitis within 52.6 seconds on average.

Past studies have shown improvement using Sinus Buster, but this is the first controlled study demonstrating efficacy.

Of note, unlike nasal decongestant sprays like Afrin which can result in addiction over time (rhinitis medicamentosa), there does not appear to be any addictive component with this nasal spray.

Read the study abstract here.

Read more about this condition here.

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Reference:
A randomized, double-blind, parallel trial comparing capsaicin nasal spray with placebo in subjects with a significant component of nonallergic rhinitis. Annals of Allergy, Asthma & Immunology. Volume 107, Issue 2, Pages 171-178 (August 2011)

Intranasal Capsicum spray in idiopathic rhinitis: a randomized prospective application regimen trial. Acta Otolaryngol. 2009 Apr;129(4):367-71.

Intranasal capsaicin reduces nasal hyperreactivity in idiopathic rhinitis: a double-blind randomized application regimen study. Allergy. 2003 Aug;58(8):754-61.

The long-term effects of capsaicin aqueous spray on the nasal mucosa. Clin Exp Allergy. 1998 Nov;28(11):1351-8.

Beneficial effects of intranasal applications of capsaicin in patients with vasomotor rhinitis. Eur Arch Otorhinolaryngol. 1991;248(4):191-4.

Saline Nasal Flush – Mayo Clinic Video

Ever since our office produced one of the first videos on saline nasal flushes back in December 5, 2007, there have a been a number of additional videos created by medical offices and companies ever since.

The most recent is Mayo Clinic which you can watch here.

Here’s our video we made back in 2007.

Allergies Associated with Heart Disease!

First weight gain and now heart disease. Allergies is certainly getting bad rap (though it has been associated with decreased risk of cancer).

Researchers in Philadelphia have found an association between allergies and heart disease when analyzing data from more than 8,600 adults aged 20 or older who participated in the National Health and Nutrition Examination Survey conducted between 1988 and 1994.

After adjusting for other related factors, such as age and asthma, there was a 2.6-fold increased risk of heart disease with wheezing and a 40 percent increased risk with rhinoconjunctivitis, compared to no allergies.

Researchers suggested that the intermittent inflammation that comes with allergies may lead to the thickening of artery walls with subsequent development of heart disease. It could also be that some people simply carry genes that are linked to the development of both allergies and heart disease.

Clearly more research is needed to clarify this relationship.

Reference:
Relation Between Common Allergic Symptoms and Coronary Heart Disease Among NHANES III Participants Am J Cardiology Received 19 March 2010; accepted 20 May 2010. published online 13 August 2010.

Antihistamines Associated With Weight Gain!

Yale researchers have found an association between obesity and antihistamine use based on data from the 2005–2006 National Health and Nutrition Examination Survey (NHANES). In the study, adults taking prescription H1 antihistamines were matched by age and gender with controls and compared on the basis of body measurements, plasma glucose, insulin concentrations, and lipid levels.

What does tbis mean? It means that there is an association and not necessarily a cause-and-effect between weight gain and antihistamine use. In order to truly determine whether antihistamines actually CAUSES weight gain, prospective studies need to be obtained.

It may be that antihistamines does not cause obesity, but that obesity may lead to increased risk of allergies which makes people take more antihistamines.

OR… perhaps there is a 3rd unknown factor that causes both problems?

It’s not clear right now and more studies are required to clarify this finding…

Reference:
Association of Prescription H1 Antihistamine Use With Obesity: Results From the National Health and Nutrition Examination Survey Obesity (2010) doi:10.1038/oby.2010.176

Got Allergies? Maybe It’s Actually Non-Allergic Rhinitis

USA Today published a story on Aug 22, 2010 describing a condition called “Non-Allergic Rhinitis” or “Vasomotor Rhinitis” which essentially is having pretty much all the symptoms of classic nasal allergies, but caused NOT by allergies!

Such symptoms include:
- Runny nose
- Nasal congestion
- Post-nasal drainage
- Nasal obstruction
- Sinus pressure
- Sneezing
etc

These individuals also report that their nasal symptoms are triggered not only by pollen and dust, but also perfumes, strong odors, cigarette smoke, chemicals, cold air, high wind, humidity, and certain foods, especially spicy ones.

The way I try to explain this condition from those suffering from it is to consider their nasal lining to be hypersensitive… so hypersensitive that things which ordinarily shouldn’t cause any problems, do.

The best way to address this condition is by avoiding known triggers and keeping the nose clean by regular saline washes. The saline washes are quite important in that they clean out the substances which are irritating the nose (much like washing your skin reduces the irritation if you get poison ivy).

Some patients may benefit from medications like anti-histamine and steroid nasal sprays, but such medications do not work as well as for those suffering from classic nasal allergies.

Barrier type of medications like ponaris may also be helpful. Such medications work by creating an oily barrier such that the irritating substances don’t actually touch the lining itself when breathed in (much like chapstick on lips).

Some patients with non-allergic rhinitis and large turbinates may benefit from a surgical procedure called turbinate reduction, but rarely cure the problem. At best, there is perhaps a 50% reduction in symptoms.

One should also be aware that you can have BOTH allergic and non-allergic rhinitis.

Read the USA Today article here.

USNews: Cold versus Allergies… How to Tell The Difference

US News and World Report came out with a story on July 27, 2010 regarding how one can tell the difference between an allergy versus a cold, especially since each has symptoms in common.

Especially with mild symptoms, it may be hard even for an ENT to distinguish the two. Add chronic sinus infections and flu to the mix, it can be downright difficult without allergy testing, CT scans, and other types of testing to come up with a correct diagnosis.

To help distinguish among these possible illnesses, at least based on history, here is a chart our office has made.

NIH also has produced a chart that can be seen here.

Click here to read the US News & World Report story.

Kids Who Eat Fish and/or Live On a Farm At Less Risk of Allergies Later in Life!

Researchers in Germany who have followed thousands of families with children have discovered that children who eat fish before the age of 9 months had less allergies 4.5 years later than children who did not eat fish at the same age.

Furthermore, they found that school-age kids living on/near a farm were two-thirds less likely to suffer from hay fever or asthma than children with no exposure to a farm.

These studies will be published soon. Read the media report here.

Our office provides allergy testing and allergy shots / allergy drops.

Dr. Chang Featured in TV Medical News Program on CBS 6/5/10

On May 21, 2010, a video crew came to our office to film a segment on Dr. Chang and what he does (or rather a very small part of what he does) as an otolaryngology-head and neck surgeon.

Dr. Chang along with 9 other practices were featured in a medical news television show “American Health Front” that aired on June 5, 2010 at 7PM on Channel 9 (WUSA-TV CBS).

The main focus of what Dr. Chang talked about are the different causes of nasal obstruction and their treatment including:

Allergies
Septal Deviation
Turbinate Hypertrophy
Adenoid Hypertrophy
Nasal Polyps

Dr. Chang to be Featured in TV Medical News Program on CBS

On May 21, 2010, a video crew came to our office to film a segment on Dr. Chang and what he does (or rather a very small part of what he does) as an otolaryngology-head and neck surgeon.

Dr. Chang along with 9 other practices will be featured in a medical news television show “American Health Front” that will air on June 5, 2010 at 7PM on Channel 9 (WUSA-TV CBS).

The main focus of what Dr. Chang talked about are the different causes of nasal obstruction and their treatment including:

Allergies
Septal Deviation
Turbinate Hypertrophy
Adenoid Hypertrophy
Nasal Polyps