Detection of Septum Problem

Good day doctor.

After a road race last weekend, I had what felt like an allergic reaction to some wood smoke and was stuffed up for hours.  I relieved the blockage with Afrin.  Since then, I haven't been producing an mucus or had a runny nose, but have felt a slight tickling in my nasal passages when I inhale.  It's not painful, just sort of weird-feeling, and has persisted for over a full week now.  No other symptoms or illness.

On Monday, I went to my doctor, and he said I probably just had "a very low-grade cold."  However, because of some issues in my past - I was a nose-picker as a kid, used to snort drugs (mostly ADD meds), hit my head a few weeks ago - I asked him to look and see if there was any structural damage to the inside of my nose.  He looked and said that it looked perfectly healthy.  My question is, would he have been able to see signs of a "perforated septum" from a cursory look (maybe 3-4 seconds looking in each nostril with that light/magnifying tool)?  Or would this require a more specific test?

Also, any thoughts on how to make this tickling feeling go away?  I've been using a saline nasal spray, which seems to offer only temporary relief.

Thanks in advance.

[Naveen Kumar, MD]

Dear vermontrunner,

Thanks for the query

Stuffy nose with nasal discharge following exposure to wood smoke seems to be an exaggerated response to allergens. You have already used pseudoephedrine (Afrin) to reduce the nasal congestion, but it has given you only temporary relief.

I feel you would require a steroid nasal spray and an antihistaminic for some time to control nasal irritation. Also, continue using the saline nasal drops (it keeps the mucosa hydrated), drink plenty of warm water and do steam inhalation to relieve the nasal congestion and irritation.

According to the examination findings of your doctor, the nose seems to be clear and there are no signs of infection. It is very unlikely that a doctor would miss a perforation of the nasal septum. The symptoms of the septal perforation include recurrent episodes of dryness of the nose followed by nasal bleed, whistling sound while breathing (if the perforation is small), any history of infection of nasal septum followed by pus discharge from the septal region, septal surgery, snorting of long duration, etc. Most of the septal perforations happen in the front 1/3 of the nose rather than behind the nose, and can be seen easily, even on self examination using a mirror. And, hence it is very unlikely that a person will miss the perforation.

Hope that this information helps and hope that you will get better soon.

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Best Regards,
Dr. Naveen Kumar.

[vermontrunner]

It may also be relevant that I haven't had a nosebleed in probably 20 years (I'm 32 now) and that the air has been very cold and dry where I live.  The slight discomfort I'm feeling is nonexistent when I take a hot shower and when I run.