[41M] With chronic nasal congestion and recent dry cough

Patient Description

A 41-year-old male presents with severe nasal congestion and pain that has persisted for several years following two nose surgeries. The patient finds relief from congestion with Afrin. He also reports a moderate dry cough that has been ongoing for the past two months, which worsens when lying down. Additional symptoms include ringing in the ears, facial pain or pressure around the sinuses, green nasal discharge, and dry eyes. There are no reports of fever, chills, shortness of breath, chest pain, or changes in the sense of smell or taste. The patient has no pre-existing conditions or chronic illnesses and is currently taking Azelastine and Zyrtec.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are some possible explanations for your symptoms:

  • Chronic Sinusitis: Given your history of nasal congestion and pain since 2015, along with green nasal discharge and facial pain, chronic sinusitis is a likely possibility. Chronic sinusitis is an inflammation of the sinuses that lasts for more than 12 weeks despite treatment attempts.

    • Treatment: Treatment often involves nasal corticosteroids, saline nasal irrigation, and in some cases, antibiotics if a bacterial infection is suspected. In severe cases, surgery might be necessary.
  • Allergic Rhinitis: Your use of allergy medications like Azelastine and Zyrtec suggests that allergies might be contributing to your symptoms. Allergic rhinitis can cause nasal congestion, runny nose, and post-nasal drip, which might be contributing to your dry cough.

    • Treatment: Avoiding known allergens, using antihistamines, and nasal corticosteroids can help manage symptoms.
  • Non-Allergic Rhinitis: This condition can cause chronic nasal congestion and is not related to allergies. It can be triggered by environmental factors, medications, or irritants.

    • Treatment: Treatment may involve avoiding triggers, using nasal sprays, and sometimes decongestants.
  • Eustachian Tube Dysfunction: The ringing in your ears (tinnitus) could be related to issues with your Eustachian tubes, which help equalize pressure in your ears. This can be related to sinus issues or allergies.

    • Treatment: Treatments may include nasal decongestants, antihistamines, or nasal corticosteroids.

What you can do

While it's important to consult with a healthcare provider for a formal diagnosis and treatment plan, here are some steps you can take to help manage your symptoms:

  1. Continue Using Your Medications: Continue using Azelastine and Zyrtec as directed by your healthcare provider.
  2. Nasal Irrigation: Consider using saline nasal irrigation (like a neti pot) to help clear out mucus and reduce congestion.
  3. Humidifier: Use a humidifier in your home to keep the air moist, which can help with nasal congestion and dry cough.
  4. Stay Hydrated: Drink plenty of fluids to help thin mucus and keep your throat moist.
  5. Elevate Your Head: When lying down, try to keep your head elevated to reduce post-nasal drip and coughing.

What you should look out for

Seek medical attention if you experience any of the following:

  • Worsening Symptoms: If your symptoms worsen or do not improve with over-the-counter treatments.
  • High Fever: If you develop a high fever (over 100.4°F) or chills.
  • Severe Pain: If you experience severe facial pain or pressure that does not improve with medication.
  • Vision Changes: If you notice any changes in your vision or severe headache.
  • Difficulty Breathing: If you experience shortness of breath or chest pain.

Remember, while these suggestions can help manage your symptoms, it's important to consult with a healthcare provider for a comprehensive evaluation and appropriate treatment.

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5 mo ago


People Also Ask


What are the common causes of chronic sinusitis?

Chronic sinusitis is often caused by infections, nasal polyps, or a deviated septum. It can also be related to allergies or immune system responses that lead to prolonged inflammation of the sinuses.


How can I manage a dry cough that worsens when lying down?

To manage a dry cough that worsens when lying down, try elevating your head with extra pillows, using a humidifier to keep the air moist, and staying hydrated. Over-the-counter cough suppressants may also help, but consult with a healthcare provider for persistent symptoms.


What is the role of Afrin in treating nasal congestion, and are there any risks associated with its use?

Afrin is a nasal decongestant that provides quick relief from nasal congestion by constricting blood vessels in the nasal passages. However, it should not be used for more than three consecutive days, as prolonged use can lead to rebound congestion, where symptoms worsen after stopping the medication.


How can Eustachian tube dysfunction be related to sinus issues or allergies?

Eustachian tube dysfunction can occur when the tubes that connect the middle ear to the back of the nose become blocked or do not open properly, often due to sinus congestion or allergies. This can lead to symptoms like ringing in the ears, pressure, or hearing difficulties.

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