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Chronic Stuffy Nose, Nasal Polyps and Fungus

Doctors are continuously searching for better ways to treat people with chronically stuffy and running noses. Two articles propose new treatments for a chronically stuffy nose: a pepper nasal spray and injection of an anasthetic and a cortisone-type drug into the nasal nerves. Many people find relief with saline irrigation, using various devices that are readily available in drugstores; check with your doctor or pharmacist for their recommendations.

If your nose is stuffy during the pollen seasons in the spring and fall, check with an allergist. Allergy injections can help control your symptoms. If your stuffy nose started after puberty, you don't have allergies and your nose is stuffy 12 months a year, allergy injections usually are ineffective. Antihistamines and decongestant pills help to control your symptoms a little. Cortisone-type pills are highly effective but have side effects, such as obesity and osteoporosis. Cortisone-type nasal sprays are safer than the pills.

Your nose is supposed to clean, heat and moisturize the air that you breathe. The inside of your nose is covered with a sticky mucous that traps dirt, pollen, mold and other pollutants and prevents them from reaching your lungs. Inside of each nostril are large ridges called turbinates that have large blood vessels in them. When the inner lining of one side of your nose fills up with pollutants, the blood vessels inside the turbinates enlarge and swell the turbinates so they stop air from entering that side of your nose and force you to breathe through the other side of your nose. Then small hairs called cilia in the lining of your nose sweep the mucous and filth toward your mouth where you swallow them and they pass from your body.

All day and night, it is normal for you to breathe through one side of your nose and then the other. It is abnormal for the turbinates on both sides to swell at the same time and cause a stuffy nose. If your nose is stuffy in the spring and fall, you probably have an allergy and need allergy tests. If you have thick yellow or green mucous, you probably have an infection and need a culture and antibiotics. If you are exposed to irritants such as hair spray or smoke, that is probably the cause, and if your stuffiness is worse in the winter, the cause is probably breathing dry, cold air. If no cause is found, your doctor usually diagnoses vasomotor rhinitis which means that he doesn't have the foggiest idea what's causing your stuffiness and the only relatively safe and effective treatment offered today is daily use of a cortisone nasal spray such as Vancenase, Beconase, Rhinocort, etc.

Since the cause of a chronically stuffy nose can be an imbalance of the nerves that control swelling of the turbinates, treatment aimed at the nerves themselves may be effective. Capsaicin, the chemical in peppers that causes your eyes and nose to run can block nerve impulses along the type c nerve fibers. A capsaicin nasal spray was highly effective in unblocking chronically running and stuffy noses (15), but more testing needs to be done before doctors can recommend it. Since it did not change the chemicals that are associated with allergy and swelling, capsaicin unblocked stuffy noses by causing the nerves in the nose to shrink the turbinates. Another study shows that injections of cortisone-type medications and xylocaine into the sphenopalatine ganglion (SPG), the nerve roots that open and close the blood vessels in the nose, markedly reduced the nasal swelling (16). This also must be considered experimental.

Chronic sinus infections associated with nasal polyps are hard to cure because doctors don't know what causes them. Nasal polyps are small finger-like, fluid-filled blisters, often associated with asthma and serious reactions to aspirin. Researchers at the Mayo Clinic found fungi in 96 percent of people with chronic sinusitis (1).

One symposium shows that sinus infections caused by fungi are common in people who have defective immunities such as HIV and hepatis C (2-13). Allergy shots and antihistamines have never been shown to control the combination of chronic stuffy noses, nasal polyps, and sinus infections that do not vary throughout the season. Doctors treat this condition with cortisones that suppress the nasal discharge, headaches, and stuffy nose a little bit, but never cure the patient and may even set the patient up for a worsening of symptoms as the years pass.

The most common fungi are alternaria, penicillium, cladosporium, aspergillus, candida and fusarium. A sinus cat scan will tell whether a person has a sinus infection. If the cat scan shows fluid levels indicating a sinus infection, the doctor should order a fungus culture of the nose. If the culture is positive for fungi, the doctor should consider treatment with antifungal medication, even though there are no good studies to show the fungal medicines cure sinusitis, because the present treatment of cortisones works only in the short run, and shortens life by causing osteoporosis, high blood pressure and obesity. If the fungus infection is positive, the person should be treated with the appropriate anti-fungal medication such as Sporanox, Lamisil or Diflucan. People with positive skin tests to molds are the ones most likely to suffer asthma attacks so severe that they have to be hospitalized (14).

Goran Falk at Uppsala University in Sweden reports that chronic burning, running and stuffy nose and sore throat is often caused by infection by the bacteria, chlamydia pneumoniae (17). All symptoms disappeared after patients took azithromycin or clarithromycin for several weeks but the symptoms recurred presumably because the patients were not treated long enough to be cured. Chlamydia and mycoplasma have also been shown to cause late-onset asthma, chronic obstructive pulmonary disease, arthritis, persistent ear infections, urinary, bladder, intestinal, stomach and vaginal disease, and more. I have cured many of these patients with 500 mg azithromycin twice a week or 100 mg of minocycline twice a day or both together for 6 to 18 months.

90 percent of people with chronic nasal congestion lasting more than one year had positive cultures by polymerase chain reaction to chlamydia, 90 percent had positive antibody titers to chlamydia and 90 percent had positive immunohistochemical biopsy findings. All burning and stuffy nose symptoms disappeared after patients took azithromycin or clarithromycin for several weeks, but the symptoms recurred, presumably because the patients were not treated long enough to be cured. This study supports several previous studies showing that mycoplasma, an intracellular bacteria similar to chlamydia, also causes nasal polyps, small finger-like projections formed from blisters on the inner lining of the nose, that can block air flow (18). People with polyps often wheeze and cough, particularly when they get infections and they also lose their sense of smell. Allergy injections, antihistamines and decongestants do not help the vast majority of people who suffer chronic non-seasonal nasal congestion. Many people can be cured by taking 500 mg azithromycin twice a week or 100 mg of minocycline twice a day or both together for 6 to 18 months.

Surgeons can remove the polyps, but the polyps usually return within a few weeks. People with nasal polyps should never take aspirin as most will eventually develop shortness of breath, itching or increased nasal stuffiness when they take it. Until recently, the only effective treatment was cortisone-like injections and pills, such as prednisone, and antibiotics to treat the infections associated with polyps. However, cortisone-type pills and injections can make you fat, weaken your bones and rarely cause hip damage, so doctors try to avoid this treatment and prescribe cortisone-type pills for only a week or two, followed by cortisone-type nasal sprays to slow the return of the polyps (19). Recent research shows that polyps may be caused by infection (22) with mycoplasma bacteria (20,24,25) or fungi (24-29)and may be treated most effectively by antibioitcs such as doxycycline (26, 27), Zithromax (28) or Roxithromycin (21), or by fungi medication such as fluconazole(1). However, this is controversial and not accepted by many doctors; discuss it with your doctor.

1) HA Homberger et al. The diagnosis and incidence of allergic fungal Sinusitis. Mayo Clinic Proceedings 1999(Sept);73(9):877-884.

2) TG Mitchell.Overview of basic medical mycology. Otolaryngologic Clinics of North America, 2000, Vol 33, Iss 2, pp 237+.

3) WA Schell. Histopathology of fungal rhinosinusitis. Otolaryngologic Clinics of North America, 2000, Vol 33, Iss 2, pp 251+.

4) B Luna, RH Drew, JR Perfect. Agents for treatment of invasive fungal infections. Otolaryngologic Clinics of North America, 2000, Vol 33, Iss 2, pp 277+.

5) MB Gillespie, BW Omalley. An algorithmic approach to the diagnosis and management of invasive fungal rhinosinusitis in the immunocompromised patient. Otolaryngologic Clinics of North America, 2000, Vol 33, Iss 2, pp 323+.

6) BJ Ferguson. Mucormycosis of the nose and paranasal sinuses. Otolaryngologic Clinics of North America, 2000, Vol 33, Iss 2, pp 349+.

7) WA Schell. Unusual fungal pathogens in fungal rhinosinusitis. Otolaryngologic Clinics of North America, 2000, Vol 33, Iss 2, pp 367+.

8) SP Stringer, MW Ryan. Chronic invasive fungal rhinosinusitis. Otolaryngologic Clinics of North America, 2000, Vol 33, Iss 2, pp 375+.

9) BJ Ferguson. Fungus balls of the paranasal sinuses. Otolaryngologic Clinics of North America, 2000, Vol 33, Iss 2, pp 389+.

10)SM Houser, JP Corey. Allergic fungal rhinosinusitis - Pathophysiology, epidemiology, and diagnosis. Otolaryngologic Clinics of North America, 2000, Vol 33, Iss 2, pp 399+.

11) BF Marple. Allergic fungal rhinosinusitis - Surgical management. Otolaryngologic Clinics of North America, 2000, Vol 33, Iss 2, pp 409+.

12) FA Kuhn, AR Javer. Allergic fungal rhinosinusitis - Perioperative management, prevention of recurrence, and role of steroids and antifungal agents. Otolaryngologic Clinics of North America, 2000, Vol 33, Iss 2, pp 419+.

13) BJ Ferguson. Fungal rhinosinusitis: A spectrum of disease - Preface. Otolaryngologic Clinics of North America, 2000, Vol 33, Iss 2, pp XIII-XIV.

14) PN Black, AA Udy, SM Brodie. Sensitivity to fungal allergens is a risk factor for life-threatening asthma. Allergy, 2000, Vol 55, Iss 5, pp 501-504.

15) HM Blom, JB Vanrijswijk, IM Garrelds, PGH Mulder, T Timmermans, RG Vanwijk. Intranasal capsaicin is efficacious in non-allergic, non-infectious perennial rhinitis. A placebo-controlled study. Clinical and Experimental Allergy 27: 7 (JUL 1997):796-801. Address HM Blom, Erasmus Med Ctr, Dept Otorhinolaryngol, Dr Molewaterplein 40, NL-3015 Gd Rotterdam, Netherlands.

16) A Prasanna, PSN Murthy. Vasomotor rhinitis and sphenopalatine ganglion block. Journal of Pain and Symp0tom Management 13: 6(JUN 1997):332-338. Address A Prasanna, Royal Hosp, Dept Anaesthesia, POB 1331, Seeb PC 111, Muscat, Oman.

17) Goran Falck. Uppsala University Hospital in Sweden. presented to the 38th International Conference on Antimicrobial Agents and Chemotherapy November, 1998.

18) PA Gurr, A Chakraverty, V Callanan, SJ Gurr. The detection of Mycoplasma pneumoniae in nasal polyps. Clinical Otolaryngology 21: 3 (JUN 1996):269-273.

19) el Naggar M, Kale S, Aldren C, Martin F. Effect of Beconase nasal spray on olfactory function in post-nasal polypectomy patients: a prospective controlled trial. Department of Otolaryngology, North Riding Infirmary, Middlesbrough, Cleveland, UK. J Laryngol Otol 1995 Oct;109(10):941-4. We conclude that topical beclomethasone does not improve olfaction following nasal polypectomy.

20) PA Gurr, A Chakraverty, V Callanan, SJ Gurr. The detection of Mycoplasma pneumoniae in nasal polyps. Clinical Otolaryngology 21: 3 (JUN 1996):269-273.

21)M Nonaka, R Pawankar, S Tomiyama, T Yagi.A macrolide antibiotic, roxithromycin, inhibits the growth of nasal polyp fibroblasts. American Journal of Rhinology, 1999, Vol 13, Iss 4, pp 267-272.

22) T Norlander, M Bronnegard, P Stierna. The relationship of nasal polyps, infection, and inflammation. American Journal of Rhinology, 1999, Vol 13, Iss 5, pp 349-355.

23)GW Ward, JA Woodfolk, ML Hayden, S Jackson, TAE PlattsMills. Treatment of late-onset asthma with fluconazole.Journal of Allergy and Clinical Immunology, 1999, Vol 104, Iss 3, Part 1, pp 541-546.

24) M Kraft, GH Cassell, JE Henson, H Watson, J Williamson, BP Marmion, CA Gaydos, RJ Martin. Detection of Mycoplasma pneumoniae in the airways of adults with chronic asthma. American Journal of Respiratory and Critical Care Medicine 158: 3 (SEP 1998):998-1001.

25) JAMA, 1997 (December 17);278(23):2051-2.

26) Annals of Allergy, Asthma and Immunology 1998(Jan);80(1):45-49.

27) Hahn DL. Treatment of chlamydia pneumoniae infection in adult asthma: A before -after trial. J Fam Pract. 1995;41:345-351.

28) JD Klausner, D Passaro, J Rosenberg, WL Thacker, DF Talkington, SB Werner, DJ Vugia. Enhanced control of an outbreak of Mycoplasma pneumoniae pneumonia with azithromycin prophylaxis. Journal of Infectious Diseases 177: 1 (JAN 1998):161-166.

Checked 1/12/16

May 30th, 2014
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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