Nasal Lesions and Chronic Congestion
A 27-year-old male presents with a diagnosis of a deviated septum accompanied by turbinate hypertrophy. He reports experiencing significant congestion in his right nostril for the past year, which has severely impacted his ability to sleep and breathe. After being a smoker for a decade, he quit smoking in the past year due to these ongoing issues. **Symptoms:** The patient has been dealing with worsening morning headaches, a sore throat, recurrent ear infections that affect his hearing, persistent congestion in the right nostril, a complete loss of smell in that nostril, bulging and pain in the eyes, and frequent nosebleeds accompanied by discharge. **Current Medications:** His treatment regimen includes Flonase, Allegra, and saline nasal irrigation. The symptoms have progressively worsened over the course of a year. In December 2024, an ENT specialist performed a nasal endoscopy and recommended septoplasty and turbinate reduction. However, the surgery date is nearly one year away, and the patient is unable to reach out to his doctor about the escalating problems until May. Additionally, during the endoscopy, the ENT did not administer lidocaine and only examined the entrance of the nasal passage, which may have limited the evaluation. Recently, the patient has observed a patchy white lesion behind the turbinate that he is expected to have reduced; this lesion seems to be growing. In the past two weeks, he has also identified another lesion on his septum. Regrettably, he was unable to capture an image of the lesion located at the back of the turbinate, which appears to correlate with his congestion. However, he has documented the septal lesion, noting that although they appear similar, the turbinate lesion exhibits more pronounced white and black patches at its center. What might these lesions signify, and could they be the root cause of his worsening symptoms over the past year? Or is it possible that the underlying issue of his deviated septum, which he has lived with all his life, could suddenly be deteriorating?
Answers (1)
3/27/2025, 5:30:52 PM
OpenHealth AI
It sounds like you’re experiencing a combination of serious nasal issues that are impacting your quality of life. The presence of lesions and your ongoing symptoms can indeed be concerning. It is possible that the lesions could relate to a chronic inflammation or infection due to your deviated septum and turbinate hypertrophy, but they warrant careful evaluation to rule out other potential causes, including infections or other conditions.
Explanation:
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Nasal Lesions: The white patches you have noticed on your turbinate and septum could indicate several possible conditions, including:
- Fungal infections: Particularly relevant for patients with chronic nasal problems.
- Allergic reactions: Link between allergies and nasal tissue changes.
- Chronic inflammation: Associated with obstructive issues due to a deviated septum or turbinate hypertrophy.
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Chronic Congestion and Symptoms: The chronic nasal congestion, loss of smell, headaches, and ear infections are likely linked to your deviated septum and possibly exacerbated by the lesions. Your history of smoking could have further irritated your nasal passages.
Next Steps:
Here are some specific, prioritized actions you can take while waiting for your surgery and for further medical evaluations:
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Document Symptoms: Keep a detailed record of your symptoms, including when they worsen, and any changes in the appearance of lesions. Take photographs if you can.
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Use Saline Nasal Irrigation: Continue your saline nasal irrigation to help clear out mucus and promote healing of your nasal passages.
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Avoid Irritants: Stay away from smoke, strong odors, and allergens that can further irritate your nasal passages.
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Watch for Changes: Monitor for any changes in the lesions, including size, color, or the appearance of new symptoms like fever or increased pain.
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Consider Modifications to Medications: If you are experiencing frequent headaches or other symptoms not improving, discuss with your healthcare provider about optimizing your current treatment or conservative medication options during your next consultation.
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Emergency Signs: Seek medical attention sooner if you experience severe pain, significant changes in vision, fever, or if the lesions worsen significantly.
Encouragement:
I know it's frustrating to wait for further treatment, but staying informed and documenting your symptoms can empower you to advocate for your health. While lesions and symptoms are concerning, there are constructive steps you can take to manage your condition until your procedure is scheduled. It's important to keep communicating with your healthcare provider about these escalating issues as they arise.
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