My nose is still blocked months after winter cold. Help!

QI had a bad head cold earlier in the winter, but my sinuses are still blocked and uncomfortable. I’ve tried over the counter decongestants and a sinus rinse, but they’ve only given me temporary relief. I presume it’s linked to my cold, but I’ve no other lasting effects. What could it be and what can I do for permanent relief?

AIt is very common to have a post-viral sinusitis, including post-Covid, when bronchitis (inflammation in the lung airways) commonly results in a persistent cough. Typically, these symptoms will settle down within a few weeks, for both post-Covid sinusitis and the airway-inflammatory bronchitis. However, you should be able to speed up your recovery even at this stage.

Decongestant may give good immediate relief but commonly cause ‘rebound’ congestion within a few hours. Therefore they are not really going to solve your problem. The solution lies in understanding the medical condition. The best way to treat sinusitis is with steroid nasal spray. I suggest stopping the decongestant as it is possibly contributing to your ongoing problem. I recommend starting a steroid nasal spray as soon as possible. Beconase nasal spray is available OTC (over the counter), albeit the OTC indication is for hayfever, it also works really well for sinusitis.

The term ‘rhinosinusitis’ is more often used as sinus problems are commonly associated with nasal (nose) symptoms. It describes an inflammatory condition affecting the nasal passage and paranasal sinuses, which can occur at any age but most commonly in our 30s and 40s. The cardinal symptoms are nasal mucopurulent drainage, nasal congestion, facial pain/pressure and decreased sense of smell.

Approximately a third of patients can have nasal polyps contributing to the recurrence of the condition — these are often associated with asthma or aspirin sensitivity. In fact, there is often an allergic trigger to chronic rhinosinusitis, therefore steroid nasal drops/sprays and antihistamines are frequently the first order of treatment. Approximately 10pc may have an allergic fungal component.

You should stop smoking (if this applies) and you should try to reduce contact with potential irritants such as pollen, mold, house dustmite (easier said than done), animal dander and feather pillows/duvets. The use of a sinus rinse that can be bought in any pharmacy can wash out the allergens and help clear mucus. These are usually just a sterile salt water mixture.

If none of the above works for you, then I suggest you discuss with your GP the need to try a two- to three-week course of antibiotics in conjunction with nasal steroids, as you may have a secondary bacterial sinus infection. Symptoms that would prompt Ear Nose and Throat (ENT) specialist referral include high fevers, severe headache, visual disturbance such as double vision, persistent bloody nasal discharge or unilateral (one side of the nose only) nasal symptoms. An ENT doctor can perform nasal endoscopy to look for polyps, inflammation, obstruction and take bacterial or fungal cultures. CT sinus scans can also be performed if indicated in order to help firm up a diagnosis.

Dr Jennifer Grant is a GP with Beacon HealthCheck

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