Nasal and Throat Issues: Possible Causes and Solutions

Nasal issues? Esophageal reflux? Laryngopharyngeal reflux?

Hello, the symptoms have persisted for two months.
I have visited two small clinics four times (3 days each) and the second clinic twice (3 days each) without any improvement.
Symptoms include: 1.
A sour sensation around the bridge of the nose, along with a similar sensation in the eyes, resembling the feeling of nasal irritation or trauma.
2.
A dry sensation or foreign body sensation in the nasopharynx.
3.
Clear nasal discharge, normal nasal breathing without obstruction, and normal sense of smell.
4.
Nasal endoscopy showed redness and swelling, but no purulence.
5.
Leaning my head slightly forward increases the sour sensation in the nose.
6.
Occasionally, I feel a bit off balance, almost dizzy.
7.
About once a month, I experience postprandial dyspepsia, with gastric acid rising and swallowing it back down, but not feeling nauseous or experiencing the burning sensation in the chest as advertised.
The doctor prescribed: antibiotics for 9 days, anti-inflammatory medication for 12 days, fasting gastric medication for 3 days, medication for gastroesophageal reflux for 3 days, and vitamin B12 for 5 days.

Regarding the medication, there was no improvement.
In the first month, I only felt that breathing air through my nose to the oropharynx caused severe dryness in the morning; drinking water only alleviated it partially, and I still felt dryness in the upper part of the oropharynx.
The condition was mild, so I drank more hot water and rested without seeing a doctor, but the dry throat persisted without improvement.
In the second month, I caught a cold and started coughing, with painful swallowing due to tonsillar inflammation.
The nighttime cough became severe, with continuous coughing for eight times until phlegm was expelled.
After visiting the first hospital three times (3 days each), the cough improved, but the nasopharynx still felt dry with a foreign body sensation, and the sour sensation around the bridge of the nose persisted.
After taking antibiotics for 9 days due to the tonsillar inflammation, the doctor diagnosed sinusitis and prescribed anti-inflammatory medication.
After four visits (3 days each), the cough improved, but there was no change in the nasal symptoms.
I then switched to another hospital where nasal endoscopy showed redness and swelling without purulence.
The doctor determined it was not sinusitis and suggested it might be inflammation caused by gastroesophageal reflux.
After two visits (3 days each) and an additional 5 days, there has been no improvement.

Mr. Chen, 20~29 year old female. Ask Date: 2019/03/13

Dr. Ji Zhaoyun reply Otolaryngology

Hello, common symptoms of sinusitis include nasal congestion, yellow-green nasal discharge, fever, facial pain, foul smell, and changes in smell, but not all symptoms may appear.
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 "more virulent" bacteria are found, a stronger antibiotic may be necessary.
It is recommended to purchase a "nasal irrigator" (containing isotonic saline) and perform rinsing 1-2 times daily to enhance the treatment effect of sinusitis.
Additionally, avoid staying up late, do not smoke, and individuals with diabetes should control their blood sugar.
If sinusitis has not resolved after more than 2-3 months of treatment, it is highly likely to be "chronic" sinusitis, which requires further examination, and if necessary, surgical intervention should be considered.
It is advisable to seek evaluation from an otolaryngologist.

As for chronic pharyngitis, common symptoms include a sensation of something stuck in the throat.
It is recommended to undergo laryngoscopy (to rule out masses) and receive medication treatment.
In addition to medication, daily life precautions include avoiding lying down for two hours after eating.
Please avoid coffee, tea, cigarettes, alcohol, fried foods, and spicy foods, as these can help improve symptoms.
Based on your description, it may be a mixed condition.
If symptoms persist, it is best to consult an otolaryngologist.
Wishing you peace and health.
Director of the Department of Otolaryngology, Taichung Hospital, Ministry of Health and Welfare, Chi Chao-Yun.

Reply Date: 2019/03/13

More Info

It sounds like you have been experiencing a complex set of symptoms related to your nasal and throat issues for the past two months, and despite multiple consultations and treatments, you have not seen significant improvement. Let's break down your symptoms and explore possible causes and solutions based on current medical understanding.

Symptoms Overview
1. Nasal Discomfort: You describe a sensation of soreness around the bridge of your nose and eyes, akin to being hit or choked. This could indicate inflammation in the nasal passages or sinuses.

2. Dryness and Foreign Body Sensation: A feeling of dryness or a foreign body sensation in the nasopharynx can be associated with several conditions, including post-nasal drip, allergies, or even gastroesophageal reflux disease (GERD).

3. Clear Nasal Discharge: The presence of clear nasal mucus typically suggests a non-bacterial cause, such as viral infections or allergies, rather than a bacterial sinus infection.

4. Nasal Endoscopy Findings: The fact that your nasal endoscopy showed redness without pus is significant. It suggests inflammation rather than an active infection.

5. Head Position Sensitivity: Increased discomfort when leaning forward may indicate pressure changes in the sinuses or nasal passages.

6. Balance Issues: Feeling slightly dizzy or off-balance can be related to inner ear issues or sinus pressure affecting your vestibular system.

7. Gastrointestinal Symptoms: Occasional feelings of indigestion and acid reflux can complicate your throat symptoms, as acid can irritate the throat and contribute to a sensation of dryness or discomfort.

Possible Causes
Given your symptoms and the treatments you've undergone, several potential causes could be contributing to your condition:
1. Chronic Rhinosinusitis: Even if your endoscopy did not show pus, chronic inflammation of the nasal and sinus mucosa can lead to persistent symptoms. This condition can be exacerbated by allergies or irritants.

2. Allergic Rhinitis: Allergies can cause nasal inflammation and dryness, leading to a sensation of discomfort and post-nasal drip, which might explain your throat symptoms.

3. Gastroesophageal Reflux Disease (GERD): Your symptoms of throat discomfort and the sensation of acid reflux could indicate that GERD is contributing to your throat issues. Acid can irritate the throat and lead to a dry sensation.

4. Vasomotor Rhinitis: This non-allergic condition can cause nasal symptoms triggered by environmental factors like temperature changes, strong odors, or stress.

5. Medication Side Effects: Some medications, particularly antihistamines or decongestants, can cause dryness in the nasal passages and throat.

Recommended Solutions
1. Further Evaluation: Since your symptoms persist, consider seeking a second opinion from an ENT specialist who can perform a thorough evaluation, including imaging studies like a CT scan of the sinuses if not already done.

2. Nasal Irrigation: Regular use of saline nasal sprays or a neti pot can help keep your nasal passages moist and clear out irritants.

3. Allergy Testing: If allergies are suspected, consider undergoing allergy testing to identify specific triggers and discuss appropriate management strategies, including antihistamines or intranasal corticosteroids.

4. GERD Management: If GERD is contributing to your symptoms, lifestyle modifications (such as dietary changes, weight management, and avoiding late meals) and medications (like proton pump inhibitors) may be beneficial.

5. Hydration and Humidification: Ensure you are well-hydrated and consider using a humidifier in your home, especially during dry seasons, to alleviate dryness in your throat and nasal passages.

6. Avoid Irritants: Identify and minimize exposure to potential irritants, such as smoke, strong odors, and allergens.

7. Follow-Up: Keep a symptom diary to track your symptoms, triggers, and any changes in your condition. This information can be valuable for your healthcare provider in determining the best course of action.

Conclusion
Your symptoms are multifaceted and may require a comprehensive approach to diagnosis and treatment. It is essential to work closely with your healthcare providers to explore these potential causes and develop a tailored treatment plan. If your symptoms persist or worsen, do not hesitate to seek further medical advice. Your health and comfort are paramount, and finding the right solution may take time and persistence.

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