Persistent Nasal Congestion and Headaches: When to Seek Specialist Care

Q: Persistent Nasal Congestion and Headaches: When to Seek Specialist Care

Hello： It is recommended to visit the Department of Otolaryngology or the Department of Pulmonary Medicine for relevant examinations. <br>Wishing you safety and health. <br>Sincerely, Dr. <br>Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry o

Runny nose, headache, abnormal lung sounds?

Hello, doctor.
I would like to ask some questions: I have a history of nasal allergies and asthma since childhood, but my condition has worsened over the past month.
Last week, I visited an otolaryngologist and was diagnosed with a cold, but after nearly a week of medication, my condition has not improved at all.
My symptoms are as follows:
1.
I have excessive clear nasal discharge, which became slightly thicker after taking medication but remains very watery (colorless).
2.
I experience intermittent headaches of varying intensity; the most severe headache occurred one night, affecting both my forehead and the back of my head, to the point of tears, but it disappeared after I got up in the morning.
3.
The doctor noted significant wheezing during auscultation and prescribed two packets of cough expectorants, but my actual cough symptoms are very mild, almost nonexistent.
(In previous colds, I experienced coughing with thick phlegm, but this time it is nearly absent; there are also no wheezing sounds during normal breathing.)
4.
Over the past month, I have occasionally noticed a sound in my chest, resembling thick phlegm or drainage noises, when lying on my side at certain angles, but again, there is no coughing or abnormal sounds during normal breathing.
5.
Two weeks ago, I experienced severe pain at the junction of my right chest and abdomen (likely at the diaphragm), which I have never had before.
6.
I have not had a fever.
These symptoms are somewhat complex, and since my condition has not improved after visiting the clinic, it seems unlikely to be a simple cold.
I would like to know which department I should visit at a major hospital or what tests would be appropriate.
Thank you.

LAI, 20~29 year old female. Ask Date: 2019/03/26

Dr. Zheng Jueyi reply Otolaryngology

Hello: It is recommended to visit the Department of Otolaryngology or the Department of Pulmonary Medicine for relevant examinations.
Wishing you safety and health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2019/03/26

More Info

Based on your symptoms and medical history, it seems that you are experiencing a complex interplay of allergic rhinitis, potential sinus issues, and possibly other underlying conditions that may be contributing to your persistent nasal congestion and headaches. Given your history of allergies and asthma, it's not uncommon for these conditions to exacerbate each other, leading to more severe symptoms.

Understanding Your Symptoms
1. Persistent Nasal Congestion: The clear, watery nasal discharge you describe is typical of allergic rhinitis. When your body encounters allergens, it releases histamines, leading to inflammation and increased mucus production. This can cause the nasal passages to become congested, resulting in difficulty breathing through the nose.

2. Headaches: The headaches you experience, particularly those that are intense enough to cause tears, could be related to sinus pressure. When the sinuses become inflamed or blocked due to allergies or infection, it can lead to a buildup of pressure, resulting in pain in the forehead and back of the head. This is often referred to as sinus headache.

3. Chest Sounds and Pain: The sounds you hear in your chest when lying down could indicate post-nasal drip, where mucus drains down the back of your throat, potentially leading to irritation. The sharp pain in the diaphragm area could be related to muscle strain or irritation from coughing or deep breathing, especially if you have been experiencing increased mucus production.

When to Seek Specialist Care
Given that your symptoms have persisted despite treatment and are affecting your quality of life, it is advisable to seek further evaluation from a specialist. Here are some recommendations:
1. Ear, Nose, and Throat (ENT) Specialist: Since you have already seen an ENT, it may be beneficial to return for a follow-up. You might want to discuss the possibility of conducting imaging studies, such as a CT scan of the sinuses, to check for any obstructions, chronic sinusitis, or other structural issues that could be contributing to your symptoms.

2. Allergist: Consulting an allergist could provide insight into specific allergens that may be triggering your symptoms. They can perform skin tests or blood tests to identify sensitivities and recommend appropriate allergy management strategies, including potential immunotherapy.

3. Pulmonologist: Given your history of asthma, a pulmonologist could evaluate your lung function and determine if there are any underlying respiratory issues that need to be addressed, especially if you are experiencing chest pain or discomfort.

Recommended Tests
- Sinus Imaging: A CT scan of the sinuses can help identify any chronic sinusitis or anatomical issues.

- Allergy Testing: Skin prick tests or specific IgE blood tests can help identify allergens.

- Pulmonary Function Tests: If you have concerns about asthma exacerbations, these tests can assess your lung function.

Conclusion
In summary, your symptoms suggest a multifaceted issue that may involve allergic rhinitis, sinusitis, and possibly other respiratory conditions. Given the persistence and severity of your symptoms, it is crucial to seek further evaluation from specialists who can provide a comprehensive approach to diagnosis and treatment. This may include imaging studies, allergy testing, and a thorough assessment of your respiratory health. By addressing these issues holistically, you can work towards alleviating your symptoms and improving your overall quality of life.

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