Allergic Rhinitis: Diagnosis, Treatment, and Surgery Options

Regarding allergic rhinitis and nasal issues?

Hello, Dr.
Yeh.
I am a college student suffering from allergic rhinitis, which causes me significant discomfort, especially during seasonal changes.
I often experience nasal congestion, sneezing, and a runny nose.
I have noticed that these symptoms are most pronounced in the morning upon waking or when there are significant changes in temperature.
However, I have not undergone any tests to identify my allergens, so I am unsure what they are.
Does the hospital offer detailed testing for allergens? If so, is this test covered by insurance or is it out-of-pocket?
Additionally, my left nostril feels completely blocked.
After reviewing some Q&A content, it seems that I may have turbinate hypertrophy (dark red and firm), rather than nasal polyps, which my previous family doctor mentioned (nasal polyps seem to be a symptom of sinusitis, and I have not yet developed sinusitis).
There are no noticeable changes in the external appearance of my nose, so a deviated septum seems unlikely, although I did experience a significant nasal injury in childhood.

I have seen that laser treatment is an option, but it appears to have a risk of recurrence.
Another option is a more definitive surgical treatment, which would require hospitalization.
If my symptoms are indeed due to turbinate hypertrophy, when would be the best time to undergo this surgery? I am approaching graduate school entrance exams and would prefer not to be affected by this issue.
Also, is this surgery covered by insurance? What are the risks associated with this procedure? Thank you for taking the time to read my message.

Maikxz, 10~19 year old female. Ask Date: 2005/02/24

Dr. Ye Dawei reply Otolaryngology

Dear Sir, our hospital offers allergen testing, which is covered by health insurance.
Regarding surgery for turbinate hypertrophy, it can be performed at any time, is covered by health insurance, and carries no risk.
Attached is an article for your reference.

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"The Nose Disease Cure-All Surgery That Makes One's Nose Tingle"
In the outpatient clinic of an otolaryngologist, symptoms such as cough, headache, dizziness, and nasal congestion are quite common.
However, due to the complex causes of these symptoms, treatment can be challenging, leading patients to be drawn to exaggerated claims of "cure-all" and "guaranteed treatment." In the past two years, I have treated many patients who underwent the so-called "five-minute nose disease cure," resulting in complications such as nasal mucosal adhesions, nasal vestibule inflammation, nasal cavity narrowing, and nasal septum perforation—issues that are truly overwhelming and disheartening.
The causes of nasal congestion typically include "infection," "structural abnormalities of the nose," "allergic rhinitis," and "vasomotor rhinitis," each with its own pathogenic mechanisms and treatment approaches.
Naturally, each condition has its limits in terms of treatment efficacy, which has allowed alternative practitioners to thrive.
Below, I will briefly introduce each condition based on this classification.
Infection: The most common cause of nasal congestion is the common cold.
Once the cold resolves, the congestion typically subsides.
Bacterial infections leading to sinusitis are more severe and can cause nasal congestion, post-nasal drip, headaches, difficulty concentrating, and chronic nighttime cough.
In children, this can significantly affect sleep quality and academic performance.
If conservative treatments such as medication and nasal irrigation prove ineffective, surgical intervention may be recommended.
The traditional Luc's procedure, which involved incising the lip to remove the entire sinus mucosa, has now been completely replaced by endoscopic sinus surgery.
This technique allows for selective removal of obstructive mucosal tissue under good visualization, restoring normal sinus function.
Structural Abnormalities of the Nose: Deviated septum and chronic hypertrophic rhinitis are common issues.
A deviated septum can occur naturally at birth or as a result of trauma causing cartilage distortion.
The degree of deviation does not always correlate with nasal congestion, and the decision to correct it surgically can depend on the patient's subjective experience.
Chronic hypertrophic rhinitis refers to the thickening of normal turbinate tissue, which can lead to nasal congestion.
The turbinates, also known as nasal conchae, are normal physiological structures located on the lateral walls of the nasal cavity, and patients can often see them when examining their own nasal passages.
Sometimes, patients are misinformed that these are polyps and subjected to inappropriate cauterization procedures.
Allergic Rhinitis: Currently, there is no definitive cure for allergic rhinitis in medicine.
It is a disease caused by a specific predisposition, leading to edema of the nasal mucosa and resulting in congestion.
Treatment can be tailored based on the severity of symptoms, utilizing oral medications, nasal sprays, immunotherapy, or surgery to alleviate nasal congestion.
Vasomotor Rhinitis: Various factors can contribute to vasomotor rhinitis, including work stress, hormonal changes during pregnancy, certain antihypertensive medications, and irritants such as perfumes, temperature and humidity changes, or cooking fumes.
These factors can cause dilation and congestion of the blood vessels in the nasal mucosa, leading to symptoms of nasal congestion.
Treatment options for chronic hypertrophic rhinitis, allergic rhinitis, or vasomotor rhinitis may include conservative oral medications, nasal sprays, traditional inferior turbinate resection, and advanced laser surgery.
There is also a technique involving the placement of thermal needles beneath the turbinate mucosa, using radiofrequency to generate low heat, which causes protein coagulation in the submucosal tissue, leading to fibrosis and reduction of the hypertrophied turbinate tissue.
While nasal congestion is not classified as a disease, it is a highly bothersome symptom.
It can lead to difficulties in breathing, dizziness, headaches, lack of concentration, snoring, insomnia, or sleep apnea.
Consulting a professional otolaryngologist to identify the underlying cause of nasal congestion and selecting appropriate symptomatic treatment is the right approach.
I sincerely hope to no longer encounter claims of "cure-all" surgeries for nasal diseases in the clinic.

Reply Date: 2005/02/24

More Info

Allergic rhinitis is a common condition that affects many individuals, particularly during seasonal changes when allergens are more prevalent. It is characterized by symptoms such as nasal congestion, sneezing, and a runny nose, which can significantly impact daily activities and quality of life. Understanding the diagnosis, treatment options, and potential surgical interventions for allergic rhinitis is crucial for effective management.

Diagnosis of Allergic Rhinitis
To diagnose allergic rhinitis, healthcare providers typically begin with a thorough medical history and physical examination. They may ask about the timing of symptoms, potential triggers, and any family history of allergies. Skin prick tests or specific IgE blood tests can be conducted to identify specific allergens responsible for the symptoms. These tests can help determine whether the patient is allergic to common allergens such as pollen, dust mites, pet dander, or mold.

In terms of healthcare coverage, many insurance plans, including those under the National Health Insurance in various countries, may cover allergy testing. However, it is essential to check with your specific insurance provider to understand what is included and whether any out-of-pocket expenses may apply.

Treatment Options
The management of allergic rhinitis typically involves a combination of avoidance strategies, pharmacotherapy, and, in some cases, immunotherapy.
1. Avoidance: Identifying and avoiding known allergens is the first step in managing allergic rhinitis. This may include staying indoors during high pollen counts, using air purifiers, and regularly cleaning living spaces to reduce dust and mold.

2. Medications: Over-the-counter antihistamines (e.g., cetirizine, loratadine) can help alleviate symptoms such as sneezing and runny nose. Nasal corticosteroids (e.g., fluticasone, mometasone) are often recommended for their anti-inflammatory effects and can significantly reduce nasal congestion. Decongestants may also be used for short-term relief but should be used cautiously due to potential side effects.

3. Immunotherapy: For individuals with persistent symptoms despite medication, allergen immunotherapy (allergy shots) may be considered. This treatment involves gradually exposing the patient to increasing amounts of the allergen to build tolerance over time.

Surgical Options
In cases where nasal obstruction is primarily due to anatomical issues such as turbinate hypertrophy (enlarged nasal turbinates), surgical intervention may be necessary. Procedures such as turbinate reduction can help improve airflow and alleviate symptoms.
- Timing for Surgery: If surgery is indicated, it is advisable to schedule it at a time that minimizes disruption to your academic responsibilities, such as after exams. Recovery times can vary, but many patients return to normal activities within a week.

- Insurance Coverage and Risks: Most health insurance plans provide coverage for medically necessary surgeries, including turbinate reduction. However, it is essential to confirm this with your insurance provider. As with any surgical procedure, there are risks involved, including bleeding, infection, and potential changes in nasal function. Discussing these risks with your surgeon can help you make an informed decision.

Conclusion
In summary, allergic rhinitis can significantly affect your quality of life, particularly during seasonal changes. A thorough evaluation by an allergist or ENT specialist can help identify specific allergens and guide appropriate treatment. If conservative measures are insufficient, surgical options may provide relief. It is essential to communicate openly with your healthcare provider about your symptoms, concerns, and treatment preferences to develop a personalized management plan that aligns with your academic and personal needs.

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