Patient Question: Disease: Chronic rhinitis for many years, severe nasal congestion, stuffiness in the nose, lack of oxygen. Description: 1. Condition: Left septum deviation, nasal congestion since the second half of 2007, initially still able to breathe through the nose, then progressively aggravated, after 09 years daily breathing through the mouth. No pus and clear snot, occasional white translucent jelly-like mucus in the left nostril, no sneezing. Currently both noses are persistently severely blocked, with inadequate ventilation and severely reduced energy concentration. There is pressure and swelling when the nasal congestion is severe, mostly concentrated at the root of the nose, the temple, and near the eye of the ear in the lateral part. After using a cotton swab to penetrate deep into the nasal cavity, the swab was slightly raised upward and could touch the solid hard tissue (hard rubber ball feeling slightly elastic), and the resistance was very obvious Beijing Jian Gong Hospital Ear, Nose and Throat Wang Xianzhong 2, the treatment that had been done: in October 07 (then 16 years old) in the hospital for the correction of nasal septal deviation, the left inferior turbinate slightly cut off a small piece. Afterwards, it was ineffective. In the first half of this year, he tried to use low-dose roxithromycin orally plus coleus nasal spray in accordance with the guidelines for the treatment of rhinosinusitis, which lasted for two and a half months, but was ineffective. During the period of illness, Chinese medicine, physical therapy and nasal washings were used, but no significant effect was seen. 3. Other disease-related information: No obvious seasonal changes in nasal symptoms. Had a history of long-term use of hydroxymetazoline hydrochloride, but hardly used it in the past 3 years. A few years ago, it was very effective, but the effect slowly declined. 3 years ago, the effect continued to decline after almost no use. With the increase in nasal congestion day by day failure so far, but the effect is extremely insignificant. 4. Physical condition: male, 23 years old. Suffered from nasal disease for 7 years. Poor gastrointestinal function, stools are not formed, 2 times a day. Left lower abdomen discomfort, abdominal distension, Western medicine diagnosis of irritable bowel syndrome. He often feels weak and sleepy, has little energy, and his throat is easily inflamed due to open-mouth breathing, which often causes respiratory infections and fever. Cold and sweaty extremities in winter. Usually sweating easily. Help wanted: 1. Can I still undergo conservative treatment? I have tried almost all the reliable conservative treatment options. What other conservative treatments can I try for my case? 2. From the CT I provided, can I have another surgery in my case? (Most doctors I have seen do not recommend surgery again, but there seems to be a lack of other good options) What advice would you give me to balance the risks and benefits? 3. Do you have any other good advice? I have heard of Dr. Wang since I was a high school student and I am fortunate enough to ask for your help today. If you hadn’t opened the internet consultation channel a few months ago, I would have been your regular patient. Over the past few years, my severe nasal congestion has destroyed my energy and talents, making it difficult for me to go further in my studies. It makes me depressed and lose confidence in life. I hope you can give me a hand and help me, thank you very much! Wang Xianzhong replied: Your problem is too complicated. The main problem is that your bilateral maxillary sinuses are overdeveloped and seriously crowd the space of the nasal airway. Secondly, you have a deviated nasal septum + nodular thickening of the nasal septum mucosa + hypertrophy of the right middle and inferior turbinates compared to the left side + partial removal of the left inferior turbinate + medication rhinitis. If there is no history of previous surgery and medication rhinitis, maybe I can try to help you with surgery, but now I can’t do anything about it. Patient Question: I have a few questions for you. 1. I started to have mild nasal congestion at the age of 16, why was my breathing basically normal for many years before that? 2. I have a little bit of drug rhinitis, but I have stopped using hydroxyzoline hydrochloride for more than 3 years, and now I can’t use it even once a month. Why has the effect diminished instead? When I stopped using it before, the effect was still very obvious. If I say that the drug rhinitis, how come the more I stop, the heavier it gets? 3. My supervisor felt that occasionally, the turbinates would contract and then I would feel a “whoosh” of air in my nose and a sense of relief in my nasal cavity. The left and right nostrils are still able to return to basically normal ventilation. Doesn’t this mean that normal nasal breathing can still be maintained with normal turbinate size? What do you mean by maxillary sinus crowding space? Thank you very much~ Reply from Wang Xianzhong: Your first two questions are very good! I don’t know many rhinologists whose answers would convince you! If you can answer the first question close to the natural law, then you can be a good rhinologist. Unfortunately, I am a frog at the bottom of the well and I know very little about the outside world, so I don’t know how many rhinologists can answer your question. My answers to your questions are in my articles on this website, check them out, I don’t know if they will satisfy you. If the rhinologists who have treated you could answer your questions, you wouldn’t have bothered to ask me. As you can see, the answers from all the rhinologists you have seen before have failed to satisfy you. Patient Question: Thank you very much, Dr. Wang. Your good reputation in the patient circle is the result of your seriousness in answering patients’ questions and your caution in answering difficult questions. To be honest, being in Jinan, most of the doctors I have seen are famous doctors in hospitals, and these two hospitals should be said to have a good level in the field of ear, nose and throat, and I have also been to Tong Ren Hospital, but none of them are willing to explain the cause of the disease. Most of them also claim that it doesn’t look as serious as I described. This time you mentioned my maxillary sinus overdevelopment problem, but none of the doctors ever mentioned it. They all say “conservative treatment”, which in my opinion is “no treatment”, and don’t say anything about what to do. And I feel more and more that doctors like me, who have read ENT head and neck surgery and read some papers and treatment guidelines on pubmed, seem to be reluctant to talk about it, just like a police officer encountering a repeat offender. Prof. Wang, I have read all your articles on this website about rhinology in the last year. You are a researcher in nasal aerodynamics, so you understand the delicate relationship between nasal structure and intranasal airflow better than other doctors. The first two questions I asked, according to my own understanding, are the result of abnormal development of the nasal cavity during adolescence, resulting in changes in the distribution of airflow, which in turn acts on the nasal cavity, leading to compensations in the mucosa and changes in the regulation of the vegetative nerves. I am sorry for wasting your time, although I have said so much. One last question: Is there really nothing I can do now? Is there any way for me to recover from the worsening nasal congestion? I know you always tell your patients to keep running. Is it true that a certain percentage of patients with structural abnormalities that are not suitable for surgery have their symptoms relieved by running? This is my last chance to consult with you, and although I am heartbroken to see your “death sentence” reply in the morning, I would like to say “thank you” for your time and sincerity! Patient Question: I have a very presumptuous request for you to add a few more consultation opportunities for me. I would like to ask you for a few more consultation opportunities so that I can have the opportunity to ask you for advice again, I’m really sorry for being so presumptuous, please bear with me. Wang Xianzhong replied: I’m really ashamed! You’ve seen more of the world than I have, I’m really a frog in a well. Running may be able to relieve your discomfort and is much less risky than another surgery. You should try running first.