I have had chronic nasal congestion for over 7 years without any nasal drip or itchiness except in the spring when my hay fever acts up. Allergists insist the congestion is from allergies because I have such strong rxns to skin tests, but I feel like it could be non-allergic. I've tried every prescription pill and nasal spray and nothing does anything for the chronic congestion. It's getting increasingly harder to breathe and I can't take it anymore! My allergists don't seem to take it very seriously so I want to know what options there are in terms of surgery for inflammation of the nasal passage. Should I talk to an allergist about this, an ENT, or some sort of surgeon? I've heard of turbinate reduction surgery, has anyone had this?

Jumi - similar situation but not quite as long. I have tried pill after pill after pill all to no avail. Also tried every steroid nasal spray made (or so it seems) also to no avail. The only thing that helps me is an anti-inflammatory like Motrin. Just went back to the doc last night and he is now trying Singulair and if no go after 1 week, Astelin. We'll see.

My point, sometimes it takes experimentation to get the right medicine for you. I would be persistent with your doctor. To finally get mine to understand my seriousness, I had to go off a bit during my visit last night.

"so how are you feeling?"
"well doc, ..... AGHGH!GH!!!!!!!!"

Good luck - don't give up!

Oh and to answer your question, I would definatly see an ENT or Allergist. My opinion is an allergist based on your post. He should be able to treat both allergic and non-allergic reactions.

[This message has been edited by burgeke (edited 03-18-2003).]

I would not suggest surgery unless CT scans of your sinuses indicate that it's absolutely necessary. I had surgery a little over two years ago, and I still suffer the same symptoms as before - much the same as you describe. What I'm told now is that although my ENT did do a good job in doing what he set out to do in my sinus surgery, the fact is that I have such severe allergies (I'm allergic to everything they do skin testing for - 30 in all) that my sinuses are just chronically infected...it's like an endless cycle. My primary care doc suggested I seek out doctors involved in experimental research since I've done allergy shots, had surgery, and take tons of medicine, but nothing works. So that's what I'm doing now... seeing doctors known for their research in severe allergies and chronic sinusitis.

One thing I'd suggest is to have your allergist test your immunoglobulin E level. I just had mine tested for the first time, and it was four times the normal number (this is the antibody that stimulates the allergic response in your body). If this level is elevated, you definitely are "allergic". If not, then something else may be causing your symptoms (you can have nonallergic causes for chronic sinusitis, for example). You didn't mention how many allergies you have, but if you have as many as I do, then that may be why you're not responding to the typical remedies. There's a new Anti immunoglobulin E infusion up before the FDA (according to my allergist)... Supposedly it will bring down the levels I spoke of before, easing the allergy symptoms we all feel. One can only hope!

How did you find about this? Is it under trials? Can you find out?

I don't know any specifics on the anti-IgE infusion except for what I posted before. I know that Dr. Kaliner (has offices in Wheaton, Md., and Chevy Chase, Md.) was involved in some early clinical trials. I've only seen him once so far, however, so I haven't gotten to talk to him about it in great detail, so I have no idea when the shot is expected to be approved and available to the public. An allergist I was seeing @ Georgetown referred me to Dr. Kaliner specifically b/c he is so involved in this new infusion/shot that is due to come out soon... The Georgetown doc seems to think it might be the one thing that can help me. I'm hoping and praying that it will... If you do a Google search for "anti IgE", you'll find lots of info about this new shot. Good luck.

You can check out this site: http://www.ent-consult.com/turbinatesurgery.html

You can also do Google searches on "turbinates" "turbinate reduction" and "empty nose syndrome" and "FESS" . FESS stands for functional endoscopic sinus surgery.

I had extensive surgery, and I would not exactly recommend it. I think the dry inflammatory condition is put in the wrong diagnostic box. The rationale for surgery is that it opens up blocked sinuses and allows natural drainage. Well, my maxillaries are now wide open like a garage and there is still pain in my cheeks. Plus, I would define my condition as dry inflammatory sinusitis. I do not have drainage. One doc was even a little mystified that I had pain since my "sinuses were clear." That tells me that the drainage theory was putting me in the wrong diagnostic box.

If you read medical journals like I do, there is debate within the ENT community between gung ho surgery and reluctance. There are medical journals using the term "nasal cripple" to describe patients who underwent too much surgery. Be SURE you find an ENT who will discuss this stuff in detail with you and who will describe exactly how he/she is going to preserve turbinate function. If they say they've never heard of "empty nose syndrome" walk right out of that office.

You need tissue in your nose to warm and humidify air and to smell. Removing it to open up passageways will obviously have effects. The surgery did not make me feel like Afrin or Sudafed did. My nose seems to constantly lack normal moisture and is sometimes gummed up with small amounts of very sticky mucous.

Apparently my frontal and part of my ethmoids are still blocked, so one theory is that I need MORE surgery. I am very reluctant to do this. My theory is that if I could find medication or a change of climate to simply reduce the general inflammation, that will remove the supposed blockage and I'll be fine. How could I live for 25 years with defective physical anatomy and then have suddenly cause trouble within the past 4?

I have a feeling that many ENT's rely on the physical/structural explanation because it is the most easily observable and definable. But, when you dig in the journals you will find a lot of evidence that a significant number of patients don't get better with surgery. Now, does that mean they need more surgery or that the whole surgery theory should be revised???