Chronic Nasal and Throat Issues: Causes and Solutions

Throat and nasal issues?

Hello Doctor, I have a somewhat complex issue that has been bothering me, so I would like to seek your advice.

Symptoms:
1.
I have persistent clear nasal discharge (not thick), and occasionally experience unexplained nasal congestion.

2.
I feel like there is something in my throat (around the chin area), which makes me frequently clear my throat and spit to relieve the sensation, but it only provides temporary relief.
Other Information:
1.
When my nasal discharge is severe, taking antihistamines (like Claritin) provides significant relief (about a reduction from 100 to 20 in severity).
It also helps with nasal congestion.
However, I previously underwent allergy testing, and the doctor said I essentially have no allergies, possibly indicating a sensitivity in my body.

2.
I have been taking Celebrex (an NSAID) long-term; could this be causing non-allergic rhinitis due to prolonged use of non-steroidal anti-inflammatory drugs?
3.
I have been on Celebrex for about two years.
Two and a half years ago, I experienced autonomic nervous system dysfunction, which caused me to have a poor appetite and feel nauseous after eating, resulting in a weight loss of ten kilograms over six months.
After taking traditional Chinese medicine for six months, my condition improved significantly, and my weight stabilized.
However, I am left with the throat symptoms mentioned above.
After a while without resolution, I stopped taking the Chinese medicine.

4.
I have previously used steroid nasal sprays, which were effective at times, but after switching brands, they no longer worked.
Taking antihistamines alone does not seem to address the root of the problem.

5.
My voice does not feel hoarse, but my throat feels tight, and I feel strange when I want to sing due to the throat issue.

6.
I tend to get anxious, especially when I have many things to do or feel stressed, which sometimes leads to a reduced appetite or a sensation of food not going down after eating, causing nausea.
Once the stress alleviates, I suddenly return to normal...
I am unsure how to handle these situations.
Questions I would like to ask:
1.
How can I resolve the issue of nasal discharge?
2.
What could the throat symptom be? Is it related to the nasal discharge, or could it be chronic pharyngitis or something similar? How can I address this? I am quite distressed and worry that constantly clearing my throat and spitting might lead to throat issues, but my throat feels tight and uncomfortable, and I don’t know how to stop.
What kind of examinations should I undergo?
3.
Regarding the anxiety-related issue, should I seek help from a psychiatrist, or are there other methods? (It seems that psychiatric medications require long-term use, but I currently only experience these symptoms intermittently.)

Nickname, 20~29 year old female. Ask Date: 2024/06/27

Dr. Ji Zhaoyun reply Otolaryngology

Hello, thank you for detailing your symptoms and concerns.
Here are some possible suggestions and considerations, but please be sure to consult your specialist in person for a personalized diagnosis and treatment plan, as online consultations cannot replace an in-person examination.

1.
Issues with Runny Nose and Nasal Congestion
Your runny nose and nasal congestion may be related to non-allergic rhinitis (such as medication-induced rhinitis or others), especially since you mentioned long-term use of non-steroidal anti-inflammatory drugs (like ibuprofen).
Symptoms of non-allergic rhinitis include persistent runny nose, nasal congestion, and nasal discomfort.

Recommendations:
- Nasal Irrigation: Use saline solution to rinse your nasal passages, which can help clear excess mucus and reduce nasal inflammation.

- Avoid Triggers: If possible, reduce or discontinue the use of medications that may cause rhinitis, and discuss alternative treatment options with your doctor.

- Specialist Consultation: Consider seeing an otolaryngologist for further examination and diagnosis, such as a nasal endoscopy.

2.
Sensation of a Foreign Body in the Throat and Frequent Throat Clearing
The sensation of a foreign body in the throat and frequent throat clearing may be related to chronic pharyngitis, gastroesophageal reflux disease (GERD), or post-nasal drip.

Recommendations:
- Otolaryngology Examination: An otolaryngologist can perform laryngoscopy to assess the condition of your throat and vocal cords while ruling out the possibility of tumors.

- Gastroesophageal Reflux: If GERD is suspected, consider a gastroenterology evaluation, and you may need to use antacid medications.

- Lifestyle Adjustments: Avoid irritant foods (such as spicy or acidic foods) and maintain good dietary habits.

3.
Issues with Stress and Autonomic Nervous System Dysregulation
Stress and autonomic nervous system dysregulation may affect your digestive system and overall health.
These symptoms may require a comprehensive treatment approach, including psychological and physiological adjustments.

Recommendations:
- Psychological Counseling: Consider seeking psychological counseling or therapy to help manage stress and anxiety.

- Relaxation Techniques: Learn relaxation techniques such as deep breathing, meditation, or yoga to help reduce stress.

- Regular Lifestyle: Maintain a regular routine and healthy lifestyle to improve autonomic nervous system function.

Summary
1.
Runny Nose and Nasal Congestion: Consider nasal irrigation, avoid triggers, and see an otolaryngologist.

2.
Sensation of a Foreign Body in the Throat: Consider an otolaryngology examination to assess for chronic pharyngitis or GERD.

3.
Stress and Autonomic Nervous System Dysregulation: Seek psychological counseling, learn relaxation techniques, and maintain a regular lifestyle.
Please be sure to discuss these recommendations with your specialist in person for a personalized diagnosis and treatment plan.
I hope this information is helpful, and I wish you a speedy recovery.

Reply Date: 2024/06/27

More Info

Chronic nasal and throat issues can be quite distressing and often have multifactorial causes. Based on your symptoms and history, let's break down the potential causes and solutions for your concerns.

1. Understanding Your Symptoms:
- Persistent Clear Nasal Discharge and Occasional Nasal Congestion: This could indicate a form of non-allergic rhinitis, which can be triggered by various factors, including environmental irritants, medications (like NSAIDs), or even changes in weather. Non-allergic rhinitis can cause symptoms similar to allergic rhinitis but without the presence of allergens.

- Feeling of a Lump in the Throat (Globus Sensation): This sensation can be linked to several conditions, including chronic pharyngitis, gastroesophageal reflux disease (GERD), or even anxiety. The constant need to clear your throat may exacerbate the irritation and lead to a cycle of discomfort.

2. Potential Causes:
- Non-Allergic Rhinitis: Given that allergy tests have shown no significant allergens, your symptoms may stem from irritants in your environment or the prolonged use of certain medications. Non-allergic rhinitis can be triggered by factors such as strong odors, smoke, or even changes in temperature.

- Medication Effects: Long-term use of NSAIDs like the one you mentioned (希勒葆) can lead to medication-induced rhinitis. This condition can manifest as nasal congestion and discharge.

- Psychological Factors: Your history of anxiety and stress may contribute to your symptoms. Stress can exacerbate physical symptoms, including those related to the throat and nasal passages.

3. Management Strategies:
- Nasal Irrigation: Regularly using saline nasal sprays or performing nasal irrigation can help clear mucus and reduce inflammation in the nasal passages. This may alleviate both nasal discharge and congestion.

- Avoiding Irritants: Identify and minimize exposure to potential irritants in your environment. This includes smoke, strong perfumes, and dust.

- Medication Review: Consult with your healthcare provider about your current medications. They may suggest alternatives or adjustments to minimize side effects related to nasal symptoms.

- Throat Care: For the sensation of a lump in your throat, consider using throat lozenges or warm saltwater gargles to soothe irritation. If GERD is suspected, dietary changes and medications to reduce stomach acid may be beneficial.

- Stress Management: Since stress appears to exacerbate your symptoms, incorporating stress-reduction techniques such as mindfulness, yoga, or cognitive behavioral therapy (CBT) could be helpful. A mental health professional can provide strategies tailored to your needs.

4. When to Seek Further Evaluation:
- If your symptoms persist despite these interventions, further evaluation may be warranted. This could include:
- Referral to an ENT Specialist: They can perform a thorough examination of your nasal passages and throat, possibly using endoscopy to visualize any underlying issues.

- Gastroenterology Consultation: If GERD is suspected, a gastroenterologist can conduct tests to assess esophageal function and recommend appropriate treatment.

- Psychological Assessment: If anxiety and stress are significantly impacting your quality of life, a mental health professional can help you develop coping strategies and may suggest therapy or medication if necessary.

Conclusion:
Chronic nasal and throat issues can be complex and often require a multifaceted approach for effective management. By addressing potential environmental triggers, reviewing medications, and incorporating stress management techniques, you may find relief from your symptoms. However, ongoing communication with your healthcare providers is essential to tailor a treatment plan that best suits your needs. If symptoms persist or worsen, do not hesitate to seek further evaluation to rule out any underlying conditions.

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