For the past eight years I have suffered from chronic post nasal drip, sinus headaches, bouts of chronic faitigue, and neck and back stiffness. Intially, my GP diagnosed my condition as Sinusitis and prescribed antibiotics which did not seem to help. About 4 years ago, I saw an ENT who did a CT Scan and said I had a partially deviated septum but the condition did not suggest surgery as a cure. He prescribed a steriod nasal spray which helped but did not relieve my symptoms completely. I also used OTC drugs like Sudafed on a daily basis. Currently, I take vitamin C and Zinc supplements which help to make the symptoms more bearable. Lately, my headaches have gotten worse and Afrin is the only thing I know of that makes my headaches go away. I know Afrin is only for temporary relief, therefore, I wonder if there is any other treatment you might suggest.
Reply: --------------------------
First of all, it is important to avoid the excessive use of any topical over-the-counter vasoconstricting nasal spray such as Afrin - this type of spray should not be used regularly for more than 3-5 days or it may cause nasal airway obstruction due to what is known as "rebound". You note that you have previously been prescribed topical nasal steroid spray and that it "helped" but did not completely relieve your symptoms - I therefore make the assumption that you have not stayed on the prescription spray. Prescription nasal steroid sprays are designed for long term use and are quite safe when used according to recommended daily dosage, even daily over many years. It is possible, in fact likely, that such nasal steroid sprays may be the best single non-surgical treatment available for the management of your nasal symptoms. Furthermore, supplemental medication such as decongestants may provide added benefit during periods of more severe symptoms. However, if your symptoms can be primarily associated with a deviated septum, and maintenance treatment with topical nasal steroid combined with as-needed use of decongestant medication is generally not satisfactory for you, it may be time to consider surgical treatment. I would in any event recommend a return visit to the otolaryngologist to re-visit the problem since your current symptoms may represent progression of nasal/sinus problems beyond that which was present 4 years ago.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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