Chronic Nasal Congestion and Ear Issues: Seeking ENT Treatment Options

Medical consultation

Dear Dr.
Chi, I have been experiencing nasal congestion and runny nose every day for the past 20 years, and my symptoms worsen with even a slight cold, leading to recurrent otitis media and sinusitis.
I have undergone surgery for sinusitis once and regularly use decongestant nasal sprays to alleviate nasal mucosal congestion.
I also experience persistent tinnitus, which temporarily resolves when I take a deep breath.
Recently, I have been taking Amoxicillin-clavulanate 1000 mg twice daily and Amoxicillin 250 mg twice daily for the past 9 days, but my runny nose persists, and I have developed yellow nasal discharge, indicating little improvement.
Do you have any recommendations for further examinations or treatments?

Lao Wu, 30~39 year old female. Ask Date: 2018/04/12

Dr. Ji Zhaoyun reply Otolaryngology

Hello Mr.
Wu,
Common symptoms of sinusitis include nasal congestion, yellow-green nasal discharge, fever, facial pain, foul odor, and changes in smell, although not all symptoms may be present.
Diagnostic methods include endoscopy and imaging studies.
If acute sinusitis persists despite antibiotic treatment for more than two weeks, it is advisable to visit an otolaryngologist for bacterial culture.
If a more virulent strain of bacteria is identified, it may be necessary to switch to a stronger antibiotic.

I recommend that you purchase a nasal irrigation device (containing isotonic saline) and perform rinsing 1-2 times daily to enhance the treatment of sinusitis.
Additionally, avoid staying up late, refrain from smoking, and if you have diabetes, control your blood sugar levels.
If treatment lasts more than 2-3 months and sinusitis remains unresolved, it is highly likely to be chronic sinusitis, which requires further evaluation.
If necessary, surgical intervention may be required (or a repeat surgery may also be possible).

I suggest you seek evaluation from an otolaryngologist.
Wishing you safety and good health.
Sincerely,
Dr.
Chi Chao-Yun
Director, Department of Otolaryngology
Taichung Hospital, Ministry of Health and Welfare

Reply Date: 2018/04/12

More Info

Chronic nasal congestion and ear issues can be quite debilitating, especially when they persist for years, as you've described. Your symptoms of daily nasal congestion, runny nose, and recurrent middle ear infections (otitis media) and sinusitis (nasal sinus inflammation) suggest a chronic condition that may require a comprehensive evaluation and treatment plan.

Understanding Your Symptoms
1. Chronic Nasal Congestion: This can be caused by various factors, including allergies, structural abnormalities (like a deviated septum), or chronic sinusitis. The fact that you experience severe symptoms with minor colds indicates that your nasal passages may be particularly sensitive or inflamed.

2. Ear Issues: The connection between nasal congestion and ear problems is well-established. The Eustachian tube, which connects the middle ear to the back of the nose, can become blocked due to nasal inflammation, leading to pressure changes and fluid accumulation in the ear, resulting in ear infections or tinnitus (ear ringing).

3. Recurrent Infections: Your history of recurrent sinusitis and middle ear infections suggests that there may be an underlying issue contributing to these problems, such as anatomical variations or chronic inflammation.

Current Treatment and Its Limitations
You mentioned that you have been taking Amoxicillin-clavulanate and additional amoxicillin without significant improvement. This raises a few points:
- Antibiotic Resistance: If your sinusitis is chronic, it may be due to bacteria that are resistant to the antibiotics you are taking. A culture of nasal discharge or sinus fluid may be necessary to identify the specific bacteria and determine the most effective antibiotic.

- Nasal Decongestants: While nasal sprays can provide temporary relief, overuse can lead to rebound congestion, worsening your symptoms. It's essential to use these medications as directed and consider alternatives.

Recommended Next Steps
1. Consult an ENT Specialist: Given the chronic nature of your symptoms, a visit to an Ear, Nose, and Throat (ENT) specialist is crucial. They can perform a thorough examination, including nasal endoscopy, to visualize the nasal passages and sinuses directly.

2. Imaging Studies: A CT scan of the sinuses may be recommended to assess for structural issues, such as polyps or anatomical variations that could be contributing to your symptoms.

3. Allergy Testing: Since you have chronic nasal symptoms, allergy testing may help identify specific allergens that could be triggering your symptoms. This could lead to targeted treatment, such as allergy medications or immunotherapy.

4. Consider Surgery: If structural issues are identified, surgical options such as functional endoscopic sinus surgery (FESS) may be considered to improve drainage and reduce inflammation in the sinuses.

5. Nasal Irrigation: Regular saline nasal irrigation can help clear mucus and allergens from the nasal passages, providing symptomatic relief.

6. Long-term Management: Discuss with your doctor about long-term management strategies, including the use of intranasal corticosteroids to reduce inflammation and prevent recurrence of symptoms.

Conclusion
Chronic nasal congestion and ear issues can significantly impact your quality of life. A comprehensive evaluation by an ENT specialist, including potential imaging and allergy testing, is essential to determine the underlying causes of your symptoms. Based on the findings, a tailored treatment plan can be developed, which may include medications, lifestyle modifications, and possibly surgical interventions. Don't hesitate to seek further medical advice to address your ongoing symptoms effectively.

Similar Q&A

Effective Remedies for Chronic Nasal Congestion and Headaches

I have been experiencing long-term nasal congestion, sometimes affecting one side, and I also have occasional migraines. What methods can help cure this condition or improve my symptoms? Thank you.

Dr. Hu Kexin reply Otolaryngology
Dear Mr. Chuang, There are many causes of nasal congestion, including chronic rhinitis (such as inferior turbinate hypertrophy, allergic rhinitis, etc.), deviated septum, or chronic sinusitis, all of which can lead to persistent nasal congestion and even headaches. The treatment...

Chronic Nasal Congestion: When Allergy Medications Fail to Help

Hello Doctor, I have been experiencing nasal congestion for nearly three years, and this issue has severely affected my sleep and daily life. During my last visit to the Veterans General Hospital, the physician conducted an examination using an endoscope and found no abnormalitie...

Dr. Jian Huangqi reply Otolaryngology
You may be experiencing hypertrophic rhinitis due to long-term use of nasal sprays. You can consult Dr. Hong Yuan-tsung, the Director of the Department of Otolaryngology at Taipei City Hospital Zhongxing Branch. Thank you.

Managing Nasal Congestion and Tinnitus: Expert Advice for Relief

Dear Doctor, I would like to ask you two questions. 1. My nose has not been in good condition since childhood, and it has been getting worse in recent years. I often experience nasal allergies with frequent sneezing and a sensation of insufficient airflow. When I catch a cold,...

Dr. Jian Huangqi reply Otolaryngology
Dear Mr. Hsu: 1. You have experienced allergic reactions, along with chronic rhinitis leading to nasal congestion and post-nasal drip. It is advisable to consult an otolaryngologist (ENT specialist). 2. If there is purulent discharge from the ear, along with echoing sounds and ...

Understanding Your ENT Symptoms: When to Seek a Second Opinion

Hello Doctor: I have been experiencing frequent headaches and ear pain lately, along with continuous postnasal drip. Sometimes I can even taste a strange flavor. Additionally, I have pain at the back of my neck, specifically behind my ears. I visited an ENT specialist who said th...

Dr. Ye Dawei reply Otolaryngology
Tony: Your issue is likely due to a deviated septum, which can also cause headaches. However, please come to the clinic for a detailed endoscopic examination to gain a clearer understanding of your condition. Attached is an article for your reference titled "The 'Cure-A...