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Comment by seehafer | Hacker News Reader

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.

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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...)

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...

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.

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.)

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'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?

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.

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

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'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.

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?

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

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