The truth about turbinates (and sinusitis) | Hacker News Reader

The truth about turbinates (and sinusitis)

westportfacialplasticsurgery.com

121 pointsflreln122 comments

I had a horrendous sinus infection in 2006, and got Prednisone for it, and various other drugs, and finally it went away. Fortunately, my allergy test didn't indicate much in the way of allergies. Before that, I had regular bouts of cold-like symptoms, was on Claritin, etc. etc.

Then I heard something which (cliché alert!) changed my life: it's sinus-rinsing. I discovered that it's not some woo-woo alternative therapy; lots of people do it, and your doctor will probably give it his or her blessing. You can get the kits in any drugstore (I use NeilMed). Everyone hears "sinus rinsing" and says "Neti Pot" and that's fine, although I think its major advantage is its Eastern-sounding name. I just use the squeeze bottle. Be sure to use distilled water. The powder is just saline and baking soda, which makes it not burn the inside of your nose.

Since I started this, I get maybe one cold a year, and it goes away in a week and a half or so.

What's the technical, scientific explanation for this? "It clears the crap out of your nose" pretty well covers it.

Life-changing for me too - highly recommended. It's kind of weird and a little unpleasant at first, but has significantly reduced my allergy symptoms.

> It's kind of weird and a little unpleasant at first ...

One thing that helps is to warm up the water slightly so that it matches your body temperature.

Maybe. Once I neglected to mix in the saline - bicarbonate powder, and did it ever burn. I think that's what makes it less nasty than getting water up your nose when you're swimming.

Likewise - that's a mistake you'll only make once!

Dumb question, but how do you warm distilled water in a sterile fashion without fully boiling it? I wouldn't trust using my kettle for this since I typically use tap water, but maybe it wouldn't matter?

Assuming you are using the squeeze bottle method, as the below linked comment says, put 8 oz distilled into the plastic bottle, then nuke about 25 secs to reach approx 100 degrees F. After you do this a few times you will learn exact amount of time.

https://news.ycombinator.com/item?id=29375614

Is there a reason for distilled water over, say, an in home RO? I always assumed it was to avoid potential bacteria, amoebas, etc.

> I always assumed it was to avoid potential bacteria, amoebas, etc.

You nailed it. Misuse can be fatal due to proximity to the brain.

Distilled water is much easier to get hold of compared to a reverse osmosis system. I suspect most people can buy distilled water, but can’t access a reverse osmosis machine.

Also it’s easier to be confident that your distilled water is still mostly pure as the manufacturer will be regularly checking their output. Unless you’re running regular testing on your reverse osmosis equipment, and cleaning it and the downstream pipes, then how you be certain about the purity of your home made water?

If you are doing all that work, then home made purified water from a reverse osmosis setup is probably as good as store bought distilled water.

If you just boil the water before use (and let it cool, obviously!), there's zero risk of infection. Distilled water is generally just the easiest and simplest way to do it safely.

I'm not particularly paranoid, but I do notice mineral buildup over time from tap water. In fact, my dishwasher may be end-of-life because of it.

(and of course, as others have said, bacteria, amoeba, disinfecting chemicals, minerals from the house's pipes... did I mention that I'm not paranoid? :) :) )

But YMMV -- if you're happy with reverse osmosis, go for it.

Do you ever run a descaling cycle? You can use citric acid or a cleaning pack that's basically just Citric acid.

Plumber told me to put vinegar into it, which sounds like the same principle.

I have a dishwasher that says an upright glass of vinegar is an option if dishwasher cleaning tablets aren't powerful enough but warns that it is harsh on the plastics and seals.

If the nurzle for your RO spigot got contaminated with something that liked noses after being shoved into somebody's drink... it might start growing up there. I prefer to only fill the bottles with boiling liquid when dissolving the salt. I use a water boiler. Then you have to wait for it to cool. 20-30 sec in the microwave will bring it back to head temperature.

What I REALLY would not use is an old Britta that's been accumulating goo for the last year. Fungus is bad, hard to kill, and will eat your brain. Do you have sourdough, kombucha, or any other weird smells in your fridge? Keep it outta there!

you can use home RO if you boil it but distilled is best. I used to work in industrial water purification and I would never use water that hasn't been boiled first.

edit: and yes... look at the news every now and again where you hear of some kids swimming in a lake and dying from an amoeba or something else that jumped the brain barrier.

I do it as well, just before bed, and it certainly helps me to breathe better while I'm sleeping.

I have occasional but super painful sinus infections. One thing I don't get is, how does this sinus rinsing apparatus manage to clean out a sinus cavity which is topologically a dead end in the network of nasal air passages? Do you just have to squirt it extra vigorously to get enough turbulence to get fluid in and out? Kind of like the sight glass on a pool filter.

(Grossness warning)

Good question. I notice the water comes out the other nostril, so it can't be totally a dead end, right?

That's why I prefer the squeeze bottle to the Neti pot, actually -- more force to the water.

My impression is there is that you can get from one nostril to the other, but a sinus is a cavity attached to the side of that path with no other entry or exit point.

This is just a "spherical cow on a frictionless plane" model, but wouldn't Bernoulli's principle mean that the moving water would "pull" on the cavity's fluid somewhat?

It doesn't work immediately. You push saline from one nostril through the sinus cavity out the other nostril. It creates some turbulence and helps the mucus flow. Often water will end up stuck in your sinus and come out when you lean over later. Really, it just seems to help your sinuses clear themselves (did you know about nasal cycle which alternates congestion?). You still tend to just blow out more infected glop. Also, it's easier to tell when something bad is going on, because you'll actually see the blood in your mucus rather than just having dark boogers. That might encourage you to clean more than once.

Forgot about the "water dripping from your nose when you lean over" part. That's definitely gross!

I went to Mayo last year (immune system issues) and told the internist I had chronic gurgling in my ear. He said it was probably related to the immune deficiency and the best thing to keep the ears cleaned out are regular nasal rinses. He also recommended the NeilMedi squeeze bottle.

Now I do it every day with distilled water. Mix it in the bottle with the packets, nuke for 25 seconds, do the rinse each side, gargle with any leftover water, clean the bottle and nozzle with dish soap. Takes only a couple of minutes.

If I'm going to be out like at a store or someone's house, I wait until I get back home to do the rinse, figuring that if I've picked up any Covid cooties, this is a good way to get them cleared out of my nose before they start multiplying too much.

After my daughter was born four years ago, I went through a two year stretch of awful chronic sinus/ear infections, probably triggered by her bringing stuff home from day care. Two rounds of prednisone, probably six or seven rounds of antibiotics, even an MRI to check my auditory nerve for issues after my ears got plugged up badly after one of them. I'm deaf enough as it is and it's immensely frustrating when my ears clog up and temporarily remove what little remaining hearing I have.

Regular sinus rinsing made a huge difference in getting that under control. I'm also a big fan of the NeilMed squeeze bottles and that's what I've been using for a couple of years now. That said, this year I switched to the Xlear salt/xylitol packets and I like them better. I don't know if there's actual science to the claims that the xylitol inhibits bacterial adhesion or any of that, but I do find them gentler on my sinuses and less unpleasant if some of the solution works its way into my throat.

I don't rinse daily, but the instant I start to feel even a bit crap, I'll pull out my rinse bottle, distilled water, and packets, and have at it.

I'll be honest, the other thing that's helped is that "world events" normalized wearing masks in indoor public places, and I will continue to for a good while (the 3M Aura foldable N95 masks are _fantastic_) for things like grocery shopping. Wearing them doesn't bother me personally and definitely beats spending two weeks with my head full of crud I can't quite get rid of, or with my ears full of fluid.

I don't think you need distilled water. (Though I guess it depends on how bad your tap water is?)

Tap water can contain (no joke) brain eating parasites. You should at the very least boil the dickens out of it.

Which countries / regions have this dangerous tap water?

I'm fairly sure we don't have them in Singapore's tap water.

Every country / region. The danger here is not present when drinking the water, it's only when inserting it directly into your sinus cavity.

The naegleriasis infection has been documented in Australia in 1965, Czechoslovakia in 1962 to 1965, USA in 2003, 2011, 2013, 2020, and 2021, and Pakistan in 2008.

https://en.wikipedia.org/wiki/Naegleria_fowleri

It is advised to boil the water beforehand to kill anything that might enjoy eating its way into your brain. Store-bought distilled water is not guaranteed to be sterile afaik.

Just use tap water?

Tap water is definitely not sterile.

Yep, and has killed people via neti pot, although rare.

Microwaving water to boiling temp is an easy way to sterilize a small amount.

I'd suggest to just use your electric kettle (the same you use for making water for your tea), if you have one.

If you aren't careful, microwaved water can explode as soon as you move it. See eg https://www.stevespanglerscience.com/lab/experiments/explodi...

Do keep in mind that regular sinus rinsing does come with a few negative side-effects, too.

(I use it when I have a runny or blocked nose, and it works really well.)

Seems obvious that a structure present in pretty much ALL humans has some evolved purpose.

If you want to scare yourself, search for "empty nose syndrome" and you'll find horror stories of people feeling like something is horribly wrong after surgeons removed their turbinates (often without telling them, while doing another procedure like deviated septum) ... some even end up committing suicide.

Chesterton's Fence comes to mind:

> The more modern type of reformer goes gaily up to it and says, “I don’t see the use of this; let us clear it away.” To which the more intelligent type of reformer will do well to answer: “If you don’t see the use of it, I certainly won’t let you clear it away. Go away and think. Then, when you can come back and tell me that you do see the use of it, I may allow you to destroy it.”

Came here to talk about empty nose syndrome.

If you have any sort of general hypersensitivity or touch disorders, don’t let anybody ever touch your turbinates. You’ll likely go mad.

Note: this isn’t saying the only people to get ENS are those with a hypersensitivity/similar disorder

> Seems obvious that a structure present in pretty much ALL humans has some evolved purpose.

Contrast with the length of the recurrent laryngeal nerve:

https://en.wikipedia.org/wiki/Recurrent_laryngeal_nerve

> The extreme detour of the recurrent laryngeal nerves, about 4.6 metres (15 ft) in the case of giraffes,[27]: 74–75 is cited as evidence of evolution, as opposed to Intelligent Design. The nerve's route would have been direct in the fish-like ancestors of modern tetrapods, traveling from the brain, past the heart, to the gills (as it does in modern fish). Over the course of evolution, as the neck extended and the heart became lower in the body, the laryngeal nerve was caught on the wrong side of the heart. Natural selection gradually lengthened the nerve by tiny increments to accommodate, resulting in the circuitous route now observed.[28]: 360–362

Imagine how long the nerve must have been in long-necked sauropods:

https://bioone.org/journals/acta-palaeontologica-polonica/vo...

> The course of the recurrent laryngeal nerve appears to be an unchanging aspect of tetrapod embryology, being as developmentally fixed as the presence of a heart and paired vessels to the head. The existence of 28 m neurons in the RLN of Supersaurus may seem fantastic, but they appear unavoidable given what we know of tetrapod embryology and evolution. Other neurons in the bodies of sauropods were even longer, spanning the entire distance from the brainstem to the tip of the tail, and may have been the longest cells in the history of life. These incredible cells represent the interplay of evolutionary innovation and developmental constraint: the acquisition of giant, long-necked and long-tailed bodies built on a deeply conserved tetrapod bauplan.

>Contrast with the length of the recurrent laryngeal nerve

Yes but that is noteworthy precisely because it is the exception to the general rule. It is almost always (99%+) correct that a strange structure has some kind of meaningful purpose.

However, your own answer clearly lists the evolved purpose of that nerve - it was the simple and straight line from brain past the heart to the gills; and there is an obvious reason why it can't be changed - there's no direct mutation possible to route it to the other side.

On the other hand, there generally are possible direct mutations that would significantly reduce any tissue/structure, so if they aren't "chosen", then that does indicate that the tissue still has some purpose (which might have no relation to the purpose it had when it first appeared).

Hmm yes but a suboptimal nerve is still not the same as a useless nerve - I'm sure you wouldn't want a surgeon pulling yours out because "I don't see the use of this!" ;-)

I had a septoplasty (to fix a deviated septum) and a turbinate reduction via submucosal debrider. For the first two weeks after the operation, I experienced severe Empty Nose Syndrome. I felt like I was suffocating and short of breath all of the time. I slept two hours every night. It was excruciating in a way that I simply cannot put into words. After two days, I had thoughts of ending my life. It was that bad.

Luckily I've healed since the operation but still have mild symptoms a few months after. For a while, I had too much "openness" in my nose which felt like there was little to no air resistance. I still get that sometimes. I'm lucky though because I'm back to 70% normal. However, I'm in a private Facebook group for ENS sufferers with over 3,000 people and reading about their daily struggles is absolutely brutal, especially since I was going crazy after experiencing them for only a week or two.

For anyone considering a turbinate reduction, DO NOT DO IT. The risks are too great, and unfortunately the ENT community has a perverse incentive to hide the facts. To give you a sense of this, the week after my operation when I was struggling with the suffocating feeling, I told my ENT surgeon and he coldly offered to give me antidepressants. I was shocked and livid, because I knew that he knew exactly what was going on, but instead of acknowledging the problem, he tried to sweep it under the rug and treat it as a psychological illness. I guarantee you as someone who's experienced it, it is everything except for psychological.

You won't find good data on ENS risk because almost no ENTs will actually diagnose it. My primary ENT (not the ENT surgeon who performed the operation) basically told me that I didn't have it because I still had my turbinates. This is also blatantly false [0]. My ENT suggested that I should see a pulmonologist but my lungs are totally fine. They will do everything they can to deny and deflect responsibility. Don't let yourself been their next victim.

Feel free to reach out to me if you have more questions or are considering getting a turbinate reduction. My contact info is in my profile. I cannot urge you strongly enough to avoid this operation at all costs.

[0] https://www.youtube.com/watch?v=BVWHOQ7P3wk&t=6m13s

Damn, I got goaded into this to "fix" my sleep apnea. Didn't really fix it, I still needed a cpap. I can breathe out my nose now, but it's always felt wrong. And my sense of smell sucks.

Just to provide a counterpoint, so people aren't completely scared from the idea of turbinate reductions or septoplasty, my breathing felt amazing right after I had mine in my early 20s. Huge improvement, and I could still smell well enough to detect that a magician was using real wine on stage for a trick while seated in the front row 30 feet away.

I still would do some sort of septoplasty, before that I couldn't breathe out my nose at all. Now I use nasal pillows for my cpap, so it was mostly worth it in the end.

Second counterpoint. Incredible improvement in quality of life after turbinate reduction surgery. Air felt a little cold for a couople months, but completely normal now.

Prior symptoms: very difficult to breath through the nose at night, so had to mouthbreathe.

I totally agree that no one should remove turbinates. From my understanding almost no ENTs do it anymore as there's much more knowledge about consequences such as ENS. I was told by one ENT that many ENTs in tropical countries would get away with it because of the humid conditions.

But I should also note my story. I went to do a surgery because I had some sinus infections and an ENT lied to me that I had deviated septum. I always suffered from sleep apnea so I thought maybe it'd help fixing it. I went and did the surgery. The ENT never told me she is going to remove one of the turbinates, nor it was in the post surgery report. I found out about it by another ENT who checked my before and after scans. The surgery also caused structural change so mocus gets stuck in my nose and I suffer from dryness. I rinse but I don't find it very helpful beyond a temporary relief which I usually get from hot showers anyway. Now I do it once a week with Alkalol and xylitol.

My luck is that all the damage happened only in one nostril. I have one nostril that is perfectly fine and somehow just learned to live with this condition. The biggest issue is sleep. I now have both sleep apnea and this new issue and I even developed insomnia years after the surgery. Somehow I managed to treat my insomnia by sleeping on my side on an elevated topper and pillow. I just need to find a solution that would keep me on my side all night. CPAP also helps because of the humidifier but it's hard for me to sleep with one all night.

For forcing your body to remain on your side, there is a simple "belt" that you can wear which has attached air pockets that keep you on your side. I can't use these because my back explodes in pain, but I think they are successful for many others without such sensitive backs as mine.

https://rematee.com/

Thank you! I will look into it. I found something similar from a company called WoodyKnows I think. But the Amazon reviews were not positive so I ended up not ordering it. I usually like sleeping without a shirt and will probably be hot sleeping with something like this. But I guess it's worth trying at least if I can return it.

One reviewer mentioned their best solution was buying a vest and sewing a few pockets in the back for tennis balls.

This one was recommended to me by a specialist, I hope it works out for you!

Yikes. Sorry to hear this procedure didn't go as you hoped.

For me I tried radiofrequency at PAMF but it only lasted about a year before my nasal issues returned and I ended up getting septoplasty with turbinate reduction. For me it was mostly a success and to this date I enjoy breathing through my nose with ease. I wonder whether the difference between mine and yours is the volume of turbinate reduction.

Prior to all this I was hooked on Afrin for 2 years. Lost my sense of smell. Bloody oxymetazoline! I finally understood what drug addiction is. It was awful. The rebound effect was devastating which meant I could never get off it. The rebound effect felt like I was choking at night.

My septoplasty saved me and I no longer use Afrin. My sense of smell returned after a year post surgery.

Few weeks ago I had a cold and a stuffy nose and tried Afrin which was wonderful but stopped it after 3 days. That stuff is evil!

Today, I only use NeilMed Sinus Rinse morning and night and love it. It's the most effective way to clean your nasal passages and when sick it drains the passages of all the gunk. Cannot recommend the sinus rinse enough!

Yours is the first story I've read that's close to mine. I was sure that I had ENS after because it was so bad that I wanted to die. I told my ENT about my concerns and he said it wouldn't be possible because it was just a 25% reduction in turbinates.

It got better, but now I can't fall asleep if the air temperature isn't just right, and my chest gets really tight when I'm breathing cold air. For me it was worth it overall, but the nonchalant attitude from the ENT specialists is insane.

Wonder if a CPAP with a heated tube could help? You could control the temperature and humidity in your sinuses.

WP link https://en.wikipedia.org/wiki/Empty_nose_syndrome

YMMV, but turbinate reduction / septoplasty has led to a huge improvement in my quality of life. No ENS. Been two years since surgery, benefits still persistent just like after surgery.

Life changing, for the better.

I had turbinate reduction after a series of never-ending sinus infections. Lessened the symptoms somewhat, didn't abate. Went to an allergist, found out I was allergic to pretty much everything outside, went on immunotherapy for 5 years, haven't had a sinus infection yet. Best thing I ever did for my health.

Moral of the story: Surgeons like to do procedures. ENTs are surgeons. Act accordingly.

Thanks for sharing your experience, you've inspired me to go find an allergist. I'm tired of feeling like crap for months every spring.

I have sinusitis. Been tested twice by two different ENTs for a common allergy screening. Nothing. Should I be doing something different?

YMMV of course. Did you get skin and blood testing? I've found that dedicated allergists tend to be more thorough about this, but there's no guarantee that allergies are the cause of your sinusitis.

What do you mean by immunotherapy?

Not the person you're replying to, but probably allergen immunotherapy, aka desensitization. Basically you're given ever increasing doses of whatever it is you're allergic to. Over time, you should build up a tolerance. IIRC there are tablets available for common allergens like dust mites. For others, you need to get regular shots, which is a bit tricker and riskier.

Yes, this is correct. Generally you need regular shots. There is a startup working on a way to deliver the same regimens in oral drops: https://www.wyndly.com

Interestingly, I went to an ENT recently with chronic sinus problems.

Me: "My nose has been clogged since the 90s, I'm on three different antihistamine prescriptions, do you think surgery might help me?"

ENT: "Surgery? I mean, it might help a little. Might make things worse. What I'd really recommend is figuring out what you're allergic to. Let me write you a referral to an allergist instead."

Me, confused: "Wait, I'm allergic to something?"

ENT, more confused: "You didn't realise? Did nobody tell you you've displaying obvious symptoms? Why did you think you were on the antihistamines?"

Me: "Uh...."

So yes. I'd certainly recommend checking allergies, but the good news is, some ENTs are sensible. (Then again, this was the NZ medical system, which probably matters...)

I had mostly the same experience. Except my allergy tests all came up negative. Everyone pretty much shrugs. They all note the inflammation, even at the dentist when they do x-rays. Yet no idea what's causing it.

I imagine you're best placed to do a bisection test yourself? Like move to a different locality, cut out everything but water and be a nudist for a couple of days and see if it's improving?

Have you looked into food? I had sinus headaches my whole life and I've identified a ton of foods as the triggers. Might be worth doing an elimination diet.

This has been my experience too. I have been to several ENTs. Every one was more interested in my allergies than any sort of surgery. YMMV, but ENT stands for Ear Nose and Throat specialization. There's no surgery inherent to the treatment. Sure ENTs have been trained in basic surgeries of their specialization, but that doesn't mean they're "surgeons". It's just one tool.

Otolaryngology is considered a surgical subspeciality, at least in the US.

"The first year includes experience in general surgery ... The last four years of residency are devoted to otolaryngology–head and neck surgery training." [1]

Now, surgeons are supposed to avoid cutting where they can. The better ones do so. Same principle applies to orthopedists for that matter.

[1]https://freida.ama-assn.org/specialty/otolaryngology-head-an...

Most surgeons I've ever seen are pretty conservative. Maybe that's because I tell them I want them to be conservative but nonetheless, there it is.

I'm glad you had a better experience than I did. (I suspect you are correct about being not in a fee-for-service system having something to do with it.)

I've been to an allergist a few times and I've got seasonal allergies for pollen as well as dust mites and such. I usually sleep with my mouth open because my nose is always blocked at night which causes me to wake up in the middle of the night with a dry mouth to get water. What did you get immunotherapy for? Which allergies did it help with and how did you convince your doctor you needed it?

It could be non-allergic rhinitis like in my case. USC head of sleep surgery recommended I try the “Afrin test” which is trying Afrin for a night or two (avoid more to prevent rebound effect). Lying down can engorge nasal passages. Try elevating head via pillows or bed elevation. Use humidifier and take large dose vitamin D. Mouth tape and sleep on your side

I've been using Afrin on and off and recently went off of it because of the rebound effect. What does the test indicate though? Afrin will clear your nose regardless of allergies or not. I don't see how this test would tell me anything.

Assuming you’re cleared for allergies, it can show that it’s positional. I wouldn't use Afrin on a regular basis, or even more than two days. Try corticosteroid like flonase instead

Also hepa air purifier, vacuuming/avoding carpets, and replacing and continuously running HVAC filter/fan has helped.

What does the Afrin test indicate?

I have persistent rhinitis since I was a kid. Only two things I've tried so far help:

Afrin, which of course you can't use often due to rebound congestion but it's nice to get the occasional break.

Secondly, holding my nose shut then blowing hard against it, as if to pop your ears. For some reason this clears my airways for about 20-30 seconds which is enough to at least blow my nose.

Steroids, surgery (tonsils + adenoids) and sinus irrigation have not fixed it, but antihistamines do help a little.

Besides my nasal passages, inflammation is also noted in my eyes and gums by opticians and dentists respectively.

Speaking about inflammation in the gums, I feel like I get that too. Like sometimes the gums around my teeth taste kinda metallic or "raw" is the best way to describe it. I also get super itchy all over my body if I don't take an allergy pill at least once a week or so.

That sounds like mild food or pet allergies.

I started having this too a decade ago for no good reason. As soon as I’m lying down my nose clogs and I can’t breathe well. I’d wake up groggy, with heavy legs. It also happened randomly during the day, my nose would just start clogging. Or with alcool intake. There is no mucus clogging, it’s just the sinus les tightening and it feels like breathing through pinholes. And when I bend down, I almost always sneeze from my sinuses swelling but again no mucus.

What I’m doing is that before sleeping I’m using a spray that is 1 part mometasone to 1 part xylometazoline. 1 spray in each nostril before sleep, angled towards the opposite eye (otherwise you get nosebleeds) and now I sleep very well.

This mixture doesn’t exist ready made, I had to buy it from pharmacies that could mix medicine (it cost 100$ for a small bottle in Canada… insurance was paying but yeah). In Europe, they let you buy the two ingredients OTC or with a prescription and they’re ver cheap (like 5 eur a bottle). I then open one of the sprays and mix it 1:1.

It has the potential for tolerance so I’m very careful to use it only at night or exceptionally during the day if it’s really bad. Sometimes I can get away with 3/4 of a spray instead of a full spray in each nostril.

Of course check with a doc, but not many seem to know about this recipe. I had to see many many before one came up with it.

Interesting, I never thought about allergies.

I've had not one but two turbinate resections, each time with a different ENT. From memory, neither had even bothered to really stress some of the risks others have pointed out.

I think my quality of life improved rather substantially after the first I had. To my disappointment, it didn't last. This eventually prompted me to seek out another several years later. Again, some improvement, but this time that time window was even shorter.

I'm now at the point where I've given up and just learned to live with feeling of being completely blocked through one nostril. It's frustrating.

I find the feeling affects me most when sleeping (I've tried CPAP to get restful sleep without much success) and during heavy aerobic exercise (having to constantly blow out mucous build-up as I'm running).

It's probably good you've given up. Too many surgeries can mean a serious problem outcome like this: https://en.wikipedia.org/wiki/Empty_nose_syndrome

It sounds like you may already have some symptoms of that?

Anecdotally, I had a deviated septum correction and turbinate reduction (not complete removal.. I think they were cauterized down?) surgery last spring. It was mildly uncomfortable for a day or two after the surgery. Before the surgery I was a chronic snorer and couldn't breathe through solely my nose when running/cycling. I would get awful daily sinus headaches that would make it really difficult to focus on coding. I now no longer snore at all and can breathe through my nose all the time and am a lot more comfortable during aerobic exercise and my headaches are mostly gone. I still use antihistamines and sinus rinses to keep the rear part of my sinuses from bothering me.

Anecdata as well: I had similar conditions, procedure, and outcome.

Unfortunately though, my nose worsened (got progressively stuck again) in the few subsequent years, although, better than it was before surgery.

Only one data point, but I know someone that had radio-frequency turbinate reduction. They were suffering from constant sinus pressure and migraines that correlated with sudden changes in barometric pressure. An MRI revealed abnormally large turbinates. As far as procedures go, the RF reduction was very mild with minimal post-op. Their doctor errors on the side of caution, preferring to start small with the treatment and repeating the procedure if necessary. The first treatment worked wonders, greatly increasing QOL and nearly eliminating the migraines. It's been over a year and my friend is still very happy with the results.

Yeah I’m perplexed because that matches my experience despite the article saying I should be doomed from this course of action.

I had a problem where if I tried to breathe in deeply, especially while exercising, my nostrils would choke off and I couldn’t suck in air through my nose.

My primary care doctor said I had a deviated septum and sent me to an ENT, who agreed but said it was minor and my real problem was turbinate hypertrophy.

After a painful and bloody operation (with the RF) and a week of healing, I can be easily breathe through my nose, and this was over three years ago and I haven’t noticed anything else changing, so this is diametrically opposite all the doom and gloom.

The ENT was a dick in other ways though.

Rinsing with baby shampoo is the only thing that has ever long term helped my sinus inflammation. It’s been amazing.

https://www.nysinuscenter.com/2015/08/baby-shampoo-for-your-...

I’d never heard of this, so thank you! I’m not very excited by the prospect of surgery, and all of the other “treatments” I’ve been recommended are steeped deeply in woo, or pretty obviously a bad idea, or both. (E.g. colloidal silver.)

A little web searching even turns up an NIH study. The abstract indicates promising results with the only likely downside being a possible case of minor irritation.

https://pubmed.ncbi.nlm.nih.gov/18284857/

There’s much less precision to my method.

I use this irrigation bottle. https://www.amazon.com/Neilmed-Sinus-Rinse-Starter-packets/d...

A drop of J&J shampoo.

I rinse both nostrils while in the shower. Burns slightly. But after about a day, the irritation goes away and my sinuses feel much better.

I use to do this much more frequently, daily, but after a couple of weeks, I found it’s no longer needed as much.

If you like this reasoning absolutely read: A Hunter-Gatherer's Guide to the 21st Century

https://www.amazon.com/Hunter-Gatherers-Guide-21st-Century-C...

There is so much knowledge about how our modern world is causing much of our health problems.

Wisdom teeth: food to soft Myopia: not enough exposure to UV light while growing

Whe should know these things way before we think of medication and chirurgy. And yes, use science and technology to improve our lives when appropriate.

Thanks!

Some of those things are very speculative.

Whelp, my chance to shine. I had my turbinates surgically removed as part of sinus reconstruction. About a year after I got my face smashed really well.

Reading the surgery notes later I found out the surgeon gave me cocaine! This is apparently old fashioned but normal.

The biggest consequence is that in the nostril that isn't blocked by my bowed septum, I can stick my finger a lot further up.

Ask me anything!

This would have been great to read about before I had surgery. I had septo-rhinoplasty and turbinate reduction last year to help sleep apnoea. It was recommended by a sleep specialist who noted my nasal passages were ‘very small’. It was also recommended by two separate surgeons. It was still very hard for me to trust the surgeons, since there is a conflict of interest. Overall I was able to breathe freely through my nose for about a month and then the effect slowly wore off. Overall it is better but not life-changing or worth the gross pain and bleeding from surgery. My nose is still tender and aching a year later.

I think the article is spot-on. I always have a creeping feeling when doctors recommend surgery, as they make lots of money from cutting me open and the benefits may be dubious. I will try what this article recommends: trying to direct air through my nose at night.

A few years ago I experienced an episode of debilitating sinus pain, although generally my breathing was not obstructed. After a year of misery I was referred to some ENT surgeon. 30 seconds into consultation, after glancing at X-rays the doctor started pushing a surgery because, apparently, my mid-nasal cartilage wasn't looking straight enough for him. When I asked if it would help my sinus pain the answer was "maybe, but unlikely", but "just sign here and we'll start preparation for the operation; it is mostly covered by Medicare!". Fair to say, that consultation didn't last too long. I haven't seen any other doctor after, and the pain subsided and was completely gone in 6 months or so.

It is so blood-boiling that someone would push another person into potentially debilitating surgery just to make some money. I had a surgeon holding the pen on the consent forms and he had barely even told me what he would do. I felt sick, as I realised it was just a way to catch me off guard and not let me think about the decision.

It almost seems like according to this doctor, Oxymetazoline would be an acceptable treatment (as in, allow someone to get used to nose breathing at night for a long period of time).

I did have turbinate reduction recently, and it definitely gave me an improvement, but only about 30% I'd say. I no longer have 100% blocked nasal passages during the day, which I would during allergy season previously.

I have been using Oxymetazoline regularly, but I give myself a much smaller dose. Before nose spray and the procedure, in my case I would go to sleep with a partially clogged nose, and wake up with a fully clogged nose after a few hours. It was terrible, i'd have dreams of drowning and wake up gasping for breath. I sleep much better now. I don't experience a 'rebound affect' either.

I had something of a turbinate reduction surgery. More like a liposuction of the turbinate than a resection. The surgeon said it would be life-altering. It was, and it was a very good life alteration.

I had this done 15 years ago. For a few weeks it was life changing, then the proble, nostril went right back to 95% clogged. This is supposedly typical, but I’m sure YMMV. Glad yours didn’t regress!

I had a lavage and deviated septum correction at the same time. The lavage was probably essential.

For anybody who has had chronic sinus infections, I have some advice: Try rubbing kimchi juice inside your nostrils.

The bacteria colonizes the nose well.

This is coming from someone who has a humidifier, did nasal rinses, bought various menthols products to rinse nose, stayed in a room with 99% humidity for hours a day, took antibiotics, sprayed xylitol nasal spray, took lozenge probiotics.

Barely made a dent.

The bacteria found in kimchi seems to slowly spread deeper and deeper into your nasal cavity.

I don’t want to hypothesize too much on why it works. I’ve discovered that most of the time we really don’t understand the causal mechanisms. And even if we do, years later the explanation changes.

I’ll just simply say a lot of people have suffered from chronic sinus infections and have found relief from this route.

But if kimchi juice isn’t your thing, you can order the actual probiotic online. Just search “sinus infection probiotic”.

If you do decide to use kimchi, make sure it has garlic and doesn’t have vinegar. The garlic promotes the growth of the specific bacteria you need while the vinegar destroys it.

Ha. I had the thought the other day that if fecal transplants are effective then maybe snot transplants would be too.

Not exactly the same, but it is in the same realm.

I wonder how much this has to do with humans rarely needing to chew tough food any more (weakening the jaw, causing the mouth to open in sleep)

I had a lot of these problems growing up.

Anyone interested in following this line of thinking should look into Orthotropics[1] and Mike Mew.[2] A key insight is that bones are modeled not only according to a genetic program, but also in response to pressure - they move so as not to clash with one another, and reinforce themselves to deal with more demanding environments / greater pressures.

Personally I grew up with difficulty breathing through my nose, and didn't realize until my 30s that I had an undiagnosed tongue tie[3]. I've been applying orthotropic practices for several years and now breathe easily through my nose.

[1] https://reddit.com/r/orthotropics/

[2] https://www.youtube.com/watch?v=TY3bIMRKil8

[3] It was noted a few times over my life by dentists, but in the form of noticing the symptoms of the issue, such as a tongue thrust swallowing pattern. In my case, my breathing was restricted, but an ENT could not see why - my best guess as to why was that my airway was constricted front to back (ventral to dorsal).

As a data point of one, my guess would be not much. I've had sinus problems and turbinate surgery.

As a kid, and even as an adult, I have a weird chewing fixation. As a kid it was wet rags for some reason, as an adult pen caps and the like. And not like nibbling nervously, I'm talking chewing with molars into an unrecognizable mess. Jaws are super strong, sinuses suck.

My nose is almost permanently running or clogged. Eventually I went to see an ENT who sent me for a scan and was surprised to find that I didn't have an inferior turbinate on one side.

When I was younger I smashed my nose and had surgery so either that doctor removed the inferior turbinate during that surgery or I was just born without one.

Either way it seems to have left me in a snotty situation.

I had turbinate reduction and deviated septum repair surgery and it changed my life for the better. I sleep better, wake up more refreshed, and have more energy during the day.

> Obviously, #1 (True obstruction) can be fixed if the obstruction is relieved, and that is another topic for another day

Uuuhh I would very much like to know what the author would suggest

you cut em out

no, that's exactly what the author is saying NOT to do

All I see is Gravity's Rainbow. Am I alone?

For those that have actual turbinate obstructions like I have had, there is a new drug that can prevent their regrowth, Dupixent. Something to look into if you have failed to control this problem. It can also relieve mild asthma symptoms, so for me it was kind of a 2 for 1

As well, there is a new kind of allergy shot you can get now, where you get the injections directly into lymph nodes, and they last for 3-5 years rather than needing shots weekly etc.

tape your mouth during sleep

This... Its so wierd, but it improves my sleep. I dream more vividly aswell...

Dear diary, today hacker news made me tape my mouth shut before sleep.

How am I gonna explain this to my partner? If it stops me from snoring and him from kicking me, that‘s a win for both of us though.

I suggest "Hey partner, my weird internet friends told me if I tape my mouth shut while I sleep, it might help with snoring and improve my quality of sleep, so I'm going to try it, let me know if it works" and if your partner is snarky, be prepared with eye rolls for him to say "why only at night?"

One of my neighbors recommended thiamine supplements for help with night breathing, and my spouse was happy to have me try something. I'm sure she'd be happy to have me try taping my mouth shut overnight too.

I had some success with the thiamine, but the first suppliment pill is a B-complex with lots of stuff (all at pretty high RDA %s) and something in there makes my muscles ache in addition to seeming to help with night breathing and smelling like a vitamine shop. I've now got a liquid I'm supposed to dropper into my mouth, but it tastes and smells like a vitamin shop, which is hard for me to tolerate, and it doesn't seem to work as well (lower dosage and as bottle has been used, the dropper isn't so full). The first couple or times I used it, I noticed when waking up that I was breathing through my nose and it felt easy; that's not normal for me, I can breathe through my nose, but it usually takes some amount of concious effort to do so.

What is the liquid?

It's just thiamine(b-1?) in liquid form, plus probably some water and random inactive ingredients. But unlike the pill I had, it doesn't have a laundry list of other B vitamins. And it's supposed to be closer to 100% RDA than the 500% RDA pill.

what tape do you use?

3M Micropore Surgical Tape.

Let me just chime in here, because while often a good idea, your comment is a little sparse, and this is an idea that can weird people out.

Background: I was diagnosed with obstructive sleep apnea some years ago, and I've been sleeping with a CPAP device ever since. In general, CPAP follow-up and compliance rates are pretty terrible. Thankfully there's a very helpful community out there to help people with their various issues (reddit, apnea board, etc). I've basically tried everything and I've spoken to countless of people in the same boat. I'm just a guy on the internet, so take what I'm saying with a generous pinch of salt.

One of the most common issues with snorers and apnics (is that a word?) alike, is that things get worse when the mouth is open. When you're on nasal CPAP, opening your mouth will cause a lot of the air to simply blow out your mouth, which will reduce your effective therapeutic pressure (i.e., CPAP is now practically useless). If you're using a full face mask, an open mouth can reduce the fit of the mask, allowing escape, usually near the chin. This, too, can result in a drop in pressure, though usually not as dramatic as with a nasal mask.

There are basically zero good ways of preventing your mouth from opening at night. It happens to some people, not to others. No clue why. If it happens to you, nearly every "solution" sucks. Chin straps don't work, they will make your apnea worse by pulling your jaw into your airway, exactly where it's not supposed to be. Cervical collars are incredibly uncomfortable for sleeping. Mouthguards (like the kinds boxers use) are really uncomfortable for some people, but some people seem to tolerate them well enough.

On to the tape: there's only one reason to use it: to keep your mouth shut at night. Mouth breathing = bad. Especially when on nasal CPAP. Use a low-stick tape that's skin safe. I use a piece roughly the size of a Charlie Chaplin moustache. That's wide enough to keep my mouth shut, and narrow enough so that I can still breathe out of the corners of my mouth if I really have to. I do occasionally suffer a corner-of mouth-leak, but as it's a narrow gap, the CPAP machine can easily cope.

A word on aspirating vomit, as this seems to be a common concern. If you suffer from awful reflux, or are just unlucky enough to have to throw up while asleep, you're going to be having a bad time. Regardless of anything else. If you're on CPAP, there's a chance the pressure will be sending bits of goop down your airway. This is bad. If you're wearing a mouthguard, this will be worse. If you've taped your mouth, this too could make things worse. I once had threw up while on CPAP and mouth tape. Nothing bad happened, when the process started, it startled me and woke me up, I instinctively removed the tape and the CPAP mask before the vomit reached my mouth. Not fun, but no damage either.

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