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Spring Has Sprung

Spring Has Sprung

Spring has sprung. Or shall I declare that Spring has arrived. The pollen in the air is thick, yellow-green dust is everywhere. Consequently, patients are complaining of runny noses, sore throats and cough symptoms.

Physicians have noted since the 1800's that a catarrh or a cold is usually an independent affection, but may precede the development of another disease. Doctors have written extensively about chronic nasal catarrh, what we call today allergic rhinitis.

When a patient complains of having the inability to breathe clearly in the Spring, pollen is the allergen that usually offends the nasal mucosa. The secretions from the nose may be clear initially, but if the irritation continues, the drainage may become thick and tenacious. Most people do not lose their sense of odor although the mucous membranes may become swollen and distended. This malady was referred to as chronic nasal catarrh or rhinitis hypertrophica in the past; today it's called chronic allergic rhinitis.

When the nasal passages become obstructed, it is usually due to hypertrophy or extreme congestion of the turbinates in the nasal passages. Sometimes the adenoid tissue enlarges as well as the Eustachian tubes leading to ear infections. People who are chronically afflicted with this problem become mouth breathers, which makes it difficult for people to sleep. Their mouth and throat becomes extremely dry. Many years ago, children use to become deaf as a result of chronic congestion, some even developed mental dulness. In the old days, when surgery for nasal congestion was not an option, people suffered through the seasons with little more than salt water lavage as a treatment, but it was effective if it was done every day.

Over the years, I have seen hundreds of patients suffering from allergic rhinitis during the Spring and Hay Fever in the Fall. Many have had nasal surgery as well as resections of portions of their turbinates so they can breathe easier through their noses. What is interesting is that many ENT surgeons maintain that the breathing disturbance is initially brought on by a deviated nasal septum. No human is born, nor matures with a straight nasal septum. Everyone on our planet has a deviated nasal septum.

Straight nasal septums are created by man, not nature. Nasal congestion is created by nature also. Scraping the turbinates does not cure the problem of chronic congestion, it just allows for more congestion to occur in the tissue left behind. I think a number of small fortunes have been made straightening nasal septums and surgically reducing the thickness of the mucous membranes of patients with chronic allergic rhinitis. But the surgery rarely, if ever cures the patients reaction to environmental pollen in the Spring.

Tubes are commonly placed in children's ear drums to help reduce the effects of chronic Eustachian tube swelling that occurs from pollen and milk. Even though studies show a lack of efficacy in the procedure itself, it is a badge of courage that mother's wear proudly when they described their children having "tubes placed." Although no dairy producer would admit it, milk is one of the major contributors to chronic allergic rhinitis and Eustachian tube swelling. If most children stopped drinking milk, many cases of allergic rhinitis and chronic inner ear congestion would disappear. It is much more lucrative to sell milk and sell surgery however. As the old saying goes, a chance to cut is a chance to cure.

Miracles happen. Antihistamines and decongestants if used early and consistently work better than surgery, even though no studies exist comparing the long term outcomes of surgery verses antihistamine treatment. Corticosteroids do not affect chronic allergic rhinitis, even though people enjoy the benefit of a sinus cocktail shot. Cromolyn sodium is very helpful in preventing chronic swelling from constant mast cell activation which causes the extreme swelling, but the treatment is old school, as well as antihistamine and decongestant treatment. It seems that surgery is much sexier to many people facing the decision between medical treatment or surgery. Why? I do not know.

Surgery can straighten nasal septums, and it can provide temporary relief of chronic allergic rhinitis, but surgery cannot cure it. Only removal of the allergen can stop the swelling and the congestion. The physicians in the 1800's knew what to do: The treatment of hypertrophic rhinitis consists in the thorough cleansing of the nasal passages: Wash the nasal passages.

At that same time, those same physicians believed that "It is sad to think of the misery which has been entailed upon thousands of people owing to neglect of naso-pharyngeal catarrh by parents and physicians." No matter how you look at it, Good hygiene is still in fashion.

Take a moment to consider taking a non-sedating antihistamine in the morning, sedating antihistamines at night and/or decongestants when Spring is in the air. Do not be so quick to have sinus surgery unless you have a polyp or growth in your sinuses. It is better to breathe through your nose than your mouth just like it is better to chew and swallow food through your mouth than through your nose. However, do not lose sight that surgery could not cure hypertrophic rhinitis before or during the twentieth century and it can't cure it now.

Now go out and get a freshly cut bouquet of flowers from the back yard. But take a non-sedating antihistamine first. You'll breathe easier.

Doc

Posted by Amanda Sanders at 9:54 AM
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