Dear Doctor, After suffering for several years with chronic sinus infections, and severe nasal congestion I have been diagnosed with a deviated septum and nasal polyps. I also suffer from allergies for which I am receiving weekly injections. I currently take allegra and use astelin nasal spray to allow some nasal breathing. I am still severly congested and find little if any relief. This unfortunately is a year round condition which is aggravated by allergies. It has been suggested that I have surgery to correct this problem and at this point in time I am inclined to agree with this recommendation as I have been unable to find relief elsewhere. Does this seem like a feasible solution that will afford relief or am I going in the wrong direction? Also, about 2 1/2 years ago I began experiencing severe headaches complete with nausea and visual disturbances. The headaches were diagnosed as migraines of unknown origin. I am wondering if the headaches could be related to the breathing problems? Over the past several years I have had almost every test imaginable including CT scans of the head, IACs, and sinus an MRI of the head, an ENG, etc. they all show no major problem except the deviated septum so they have ruled out tumors, cysts, etc. Any thoughts or info you could offer would be greatly appreciated.
Reply: --------------------------
Chronic perennial nasal airway obstruction due to nasal septal deformity and/or polyps is a very appropriate indication to consider surgery, even if allergies exacerbate the condition. By the way, the medications you have mentioned (Allegra, Astelin) are antihistamines and would generally offer little benefit for chronic nasal airway obstruction. Nasal steroid sprays would have greater potential to improve this particular symptom - (Flonase, Vancenase, Rhinocort, Nasarel, Nasacort, etc.). There is considerably less likelihood that nasal or sinus surgery would be highly successful in alleviating a chronic headache condition although such surgery can be helpful in certain selected cases. In fact I rarely will recommend nasal surgery if headache is the only symptom unless certain diagnostic tests conclusively demonstrate the presence of a rhinogenic headache such as that which can occur when a sharp bony spur of the nasal septum impacts against the lateral nasal wall. In this situation, the headache may be temporarily relieved by application of a local anesthetic agent into the nasal passage. There are other explanations for so-called "sinus headaches" such as obstruction of the natural drainage pathways of the sinuses which can result in pressure dysequilibrium between the sinus cavity and ambient environment. However, if facial headaches are the only symptom experienced (ie no other sinus complaints such as post-nasal drainage, congestion, alteration in taste or smell, nasal blockage, etc.), then I would advise careful consideration before proceeding to sinus surgery as a remedy for the headache - there may be another cause for the headache and, unless there is clear objective evidence for sinus obstruction (such as significant CT scan findings), surgery may offer little benefit.
--
Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
Click here to review
previous Ear, Nose and Throat Clinic consultations