Will surgery relieve a constantly stuffy nose? Dr MARTIN SCURR answers your health questions 

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NS. My wife has congestion, sore throat and mucus build-up in the back of the throat. She gargles with salt water, inhales steam, takes congestion relief pills, and uses steroid-based sprays to relieve allergies. But nothing really helps. A GP once suggested nasal surgery to correct a deviated septum, but would it work?

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David Green, Hinckley, Leix.

a. This is almost certainly chronic rhinosinusitis, where the lining of the nose and sinuses becomes infected or inflamed by allergens.

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Inflammation creates excess mucus and also prevents it from flowing properly – so-called post-nasal drip, where mucus drips down the throat causing a sore throat, cough and the need to clear the throat.

It is possible that congestion was initially caused by a viral infection, but in more than 60 percent of cases the patient is allergic to dust mites, mold or animal dander.

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As an initial treatment to ease symptoms, try rinsing the nasal passages daily with salt water: Mix one teaspoon of salt and one bicarbonate of soda in a pint of boiled water, then cool. Buy a ‘squeeze bottle’ (or a neti pot) from a pharmacist and use the liquid to blow out the nose (instructions are readily available online).

Inflammation creates excess mucus and also prevents it from flowing properly – so-called post-nasal drip, where mucus drips down the throat causing sore throat, coughing and the need to clear the throat (stock image) )

I would recommend washing twice daily for one to two months. If there is no benefit, your wife should see her GP, who can examine the nasal cavity and check for polyps – abnormal growths of tissue that can add to the blockage.

The GP may recommend steroid nasal drops in each nostril twice daily, as these can reduce swelling in the small blood vessels located just below the lining of the nose. These blood vessels can become inflamed if the congestion is severe.

Steroid nasal sprays such as beclometasone used for allergies are usually not potent enough initially, and the recommended treatment for chronic rhinosinusitis is beclometasone nasal drops rather than sprays (your GP will need to prescribe this).

Squeeze the drops into the nose with the head in a down-and-forward position (again instructions on how to do this are available online) – if you tilt your head back, the drops will run straight down the throat into the abdomen.

More potent steroid drops can be stopped after a month or two, and then the mild spray version is used to help prevent a relapse.

A deviated septum (the cartilage dividing the nostrils) is unlikely to be the cause of your wife’s symptoms, so surgery will not help.

A deviated septum (the cartilage dividing the nostrils) is unlikely to be the cause of your wife's symptoms, so surgery won't help (stock image)

A deviated septum (the cartilage dividing the nostrils) is unlikely to be the cause of your wife’s symptoms, so surgery won’t help (stock image)

NS. With hotels and self-catering holiday outlets, at home and abroad, now reopening after a long lockdown, is there a risk of catching the water-borne infection Legionnaires’ disease from unused rain for several months?

Hector Bickerton via email.

a. Legionnaires’ disease is actually a form of pneumonia caused by Legionella bacteria, which is spread by inhaling aerosols from contaminated water – usually from showers, hot tubs and air conditioning systems (it cannot be transmitted from one person to another). could).

The condition was identified in 1976 in a group attending a convention of a US military (a veterans’ union), hence the name.

Symptoms including fever, breathlessness and cough for up to ten days after exposure. Patients usually have to be hospitalized and given antibiotics. Because a large number of organisms must be inhaled to cause infection, it is quite rare (there are only 250 cases a year in the UK). However, the mortality rate is quite high – up to 10 percent.

Legionnaires' disease is actually a form of pneumonia caused by Legionella bacteria, which is spread by inhaling aerosols from contaminated water – usually from showers, hot tubs and air conditioning systems (it cannot be transmitted from person to person). can) (stock image) )

Legionnaires’ disease is actually a form of pneumonia caused by Legionella bacteria, which is spread by inhaling aerosols from contaminated water – usually from showers, hot tubs and air conditioning systems (it cannot be transmitted from person to person). can) (stock image) )

Those most at risk include people over the age of 50, those who smoke or drink heavily and have a chronic disease (such as diabetes) or who are undergoing chemotherapy. Disinfection and monitoring of water systems for Legionella are routine practice. But not all water supplies are so well regulated, especially in some far-flung vacation spots.

One tip is to, upon arrival at your vacation accommodation, run a hot shower for several minutes, as the water temperature above 60 C (140 F) kills any Legionella bacteria lurking in the shower head. Be careful with limescale as well, as it can also harbor bacteria.

Caution may be necessary if you find housing in poor maintenance condition.

I think… we should now prioritize continuity of care

One of the fundamental tenets of good medicine is the continuity of care – an idea first propounded more than 100 years ago by William Osler, a Canadian physician who spent most of his career as a professor of medicine at the University of Oxford.

He is celebrated for many aspects of his knowledge and teaching, with a memorable phrase, ‘It is more important to know what type of disease a patient has than the disease of the patient’.

Osler believed even then that a long-term relationship between a patient and a GP is an essential requirement in order to provide effective care.

Readers of this page will be familiar with my often expressed regret that the continuity of care – where a patient is cared for by a doctor over a long period of time – has been severely compromised by changes in common practice.

Why this is so important was clearly described in a recent study published in the British Journal of General Practice, which showed that seeing the same GP for more than 15 years reduced the risk of needing hospital admission. It happens …

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