Yes, those are the best fo sure

Nosebleeds can happen and certainly do for some. Nasal hydration helps (for instance, ayr gel in combination with saline spray or irrigations). Ultimately, a good portion of patients that don’t tolerate or fail nasal steroids get surgery.

Azelaetine is fantastic - there’s a lot of patients I prescribe it in conjunction with Flonase. Allergic rhinitis or even just excessive secretions is common in patients with inferior turbinate hypertroph/nasal obstruction, and both meds have a function. They sell it as a combination, actually, but often insurance doesn’t cover the combo.

It would by a sympathetic response from catecholamines – that’s how it constricts; however, I didn’t know that it had been studied and was actually effective in real life until today.

This applies to nasal decongestants (NOT nasal steroids). Nasal decongestants (such as oxymetazoline AKA afrin, or phenylephrine based medications) are vasoconstrictors. They work very well and work very quickly as the vasoconstriction (constricting the blood vessels) which shrinks the inferior turbinates (and any other edematous tissue).

The body responds to chronic vasoconstriction by making more blood vessels. When the nasal tissues have more blood vessels (and I presume are more dense with vessels) it’s harder for the decongestant to work. This is called rebound congestion — conversely, the patients in this scenario will feel they need to use more decongestant since it previously worked so well, but it no longer does. This cycle can be challenging to treat.

For this reason most ENTs, including myself, typically recommend against afrin use for more than 3 consecutive days. I’ve seen who go as long as five, but I’m cautious and would not recommend more than 3 days.

It’s a bit funny, because if you come into my clinic and get an endosocpic exam of the nose and/or throat (i.e. probably around 50%, often more, of my patients on any given day), I will spray afrin and lidocaine into the nose before my examination. The other main thing I use it for is nosebleeds. It’s okay to use it for 3 days during an acute exacerbation of sinusitis, but I don’t really think it’s necessary.

Edit: I forgot to mention nasal steroids. As I said, the above response doesn’t apply to them. We don’t include nasal steroids in this because they have a very slow effect and don’t have the effect of rebound congestion. With few exceptions doing 2 sprays each nostril daily for a very long is fine for almost everybody, and usually helpful. When I prescribe them I recommend patients use them for at least 4 weeks. Once in awhile there are patient that I would be more cautious with prescribing nasal steroids, such as those with a septal perforation, or frequent nose bleeds. Usually it’s a non issue. Tip: when spraying them don’t spray straight back – use your opposite hand and spray towards the eye (i.e. spray with right hand into left nostril, aiming towards left eye).

It can happen, but the way most ENTs train these days, unlikely. I’ve seen it twice that I recall off the top of my head, but very rare these days.

Most ENTs, including myself, are overly cautious. You’re at a higher risk for symptom recurrence because of under resection.

That being said, I wouldn’t let an oral surgeon or general plastic surgeon touch my family member’s nose (unless they had a very very good reputation). Nothing wrong with their work, I’m just not sure they had the same training and respect for the nose.

True; I, and I’m sure most other physicians would not provide identifiable data in a public forum. If you are having issues with nasal obstruction, alternating or otherwise., best advice is to follow up with your pcm for treatment, possible referral.

The best shitposts are the ones that turn out to be real/useful.

Yeah, inferior turbinate reduction is the next small step for this. Often if it’s just alternating nasal obstruction that’s good enough. Oftentimes there’s another component of nasal valve collapse or septal deviation. Personally, in my population, I end up doing septorhinoplasty (nose job) way more often than other smaller nasal surgery.

You don’t want them to actually remove the turbinates, however. We generally just shrink them down – removing them makes the nasal air less turbulent, and difficult to sense airflow. TL;DR it make look like you can drive a semi truck through the nose, but people will feel like they cannot breathe at all. People have killed themselves over this.

Interestingly this may work, but I’m not sure anyone has studied it (perhaps I will do a lit search).

There’s erectile tissue in the inferior turbinates that is responsible for the nasal cycle… maybe after an emission it’s more flaccid?

Sadly I do not suffer from inferior turbinate hypertroohy/ alternating nasal obstruction to test this on myself.

Edit: This has been studied… I now have one more option in the “medical management” toolbox

https://doi.org/10.1177/0145561320981441

This is called the nasal cycle.

Use Flonase to help (need daily use for >= 4 weeks) If this doesn’t help enough, you should see an ENT.

Fun fact: the turbinates in the nose (which are responsible for the nasal cycle) have erectile tissue in them.

Source: your friendly neighborhood Otolaryngologist