sunny2
Forum Elite
Topics: 51
Posts: 385
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Nadiabarati......In this case if we exclude the posiibility of all those front line causes of nasal drainaige in lieu of all the tests that have been done then I can only think of the following factors....it can be due to bright lights, certain foods and spices, pregnancy and hormonal changes, various drugs including birth control pills and especially high blood pressure medications, and structural abnormalities such as a deviated or irregular nasal septum.
it can also be caused by wintertime low humidity in homes and buildings heated without adding moisture to the air. They can also result from some allergies, especially to certain foods such as dairy products.
Hope that helps !!!
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| frank100
Forum Guru
Topics: 48
Posts: 586
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since this is too chronic there are 3 options you can firt address:
1.anatomical defect
2.allergy
3.tumor.
1.the question stem doesn´t give information about the age of the patient and past medical history, but adenoid hyperthrophy, choanal defects. It seems the only diagnosis that have been managed here is chronic sinusitis (sinu CT scan and X-rays). no radiologic or endoscopic pharyngeal studies have been done. so in this case any option giving you some oportunity to "see" the pharynx can be ok.
2.this woman lives inside planet earth, so this is fair to think she is allergic to something. air carries a lot of allergens, starting from pollen, and ending in tobacco smoke. maybe she s allergic to her favorite perfume, etc...the question didn´t say anything about the nasal bones (color, mucosa), very important info when trying to rule out simple things like allergic rhinitis.
3.cancer (tumor) is the great simulator in medicine, sothink about it always, even in such benign-looking situations like this one. SOME angiofibromas do not bleed and presentation is consistent with postnasal drip. but go in go inside, do a biopsy and see is always necessary here.
If you want to be anal here what you have to do is.
1. good hx and phx
2. check diet: look for something minimum can be causing it.
3.perform general exams: CBC, immunology tests, pharyngeal radiologic studies (and neighborhood).
4. give something to address your #1 in the differential, such as Allegra, whatever..
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| nadiabarati
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But it not related to season, food .....it happens ALL the time home,outside, different cities, different countries, different continents...day in day out...
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| nadiabarati
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patient is a 37-years-old female. With no point in medical history except for, there are allergies in the family: chronic cough, urticaria, asthma in mother,aunt, sister respectively.
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| nadiabarati
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13 years duration can not match with any cancer, I think.
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| frank100
Forum Guru
Topics: 48
Posts: 586
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yes it can match a lot of tumors...but allergy seems to to be the big one.
Dr. nadiabarati, there are any labs?
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| frank100
Forum Guru
Topics: 48
Posts: 586
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just curious...isn´t this one, one of these questions someone remembers from the real test, but he cannot completely rewrite it?
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| frank100
Forum Guru
Topics: 48
Posts: 586
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nasal septum malformations can cause, exactly the same presentation.
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| nadiabarati
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NO. She is a real patient and a friend indeed and always complains about her problem. So I decided to ask you to help her. I see her to discharge her throat all the time and it's disgusting!! She is really suffering. Yes she's had nasal exam as well and it was ok. She also had pulmonary exam to see if the lungs are at fault, but they were ok.
Can you tell me which tumors can cause it? I have no idea! She has a complete CT from her head and neck and nothing is there. She's even been moving to differnt cities and countries to see if she can get rid of it, but the problem is still with her. She's seen many subspecialists in ENT, lung...
Such an allergy it can be? Day in day out!!! outdoor, indoor, any food, any environment...no relations really...All the doctors told her they don't know what it is?! ...
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| nadiabarati
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I think we must refer this case to Dr. House!! Do you watch Dr. House serials on TV?
apart from kidding, this patient really needs help!
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| frank100
Forum Guru
Topics: 48
Posts: 586
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just trying to help, but if you prefer Dr. house, YOU´RE free...
you asked for a differential: we gave it to you.
you asked for a best next step: we gave to you.
but seems that you don´t want ALLERGIES or TUMORS as part of the differential, ok you´re the one who knows the case perfectly. we are trying to help with the info you have just given, info that is not enough to make a dignosis.
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| frank100
Forum Guru
Topics: 48
Posts: 586
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by the way: I´ll pray for your friend tonight...deal?
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| nadiabarati
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Thanks for the help. I asked which tumors? because I don't know them. Of course, I want to accept any possible diagnosis, otherwise I wouldn't post my question. Thanks for the pray, but pray won't help, the etiology must be found. I also wonder if allergy can present like this. I just try to understand the case, not being in opposition to anyone to prove who is an absolute right!! Sometimes communication become a big deal and I don't know why?!!
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| nadiabarati
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what information do you need? You can ask and I'll answer!
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| cbenitesch
Forum Senior
Topics: 10
Posts: 141
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I think allergy can be a good answer,but I guess you have to rule out GERD!
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| fox
Forum Guru
Topics: 70
Posts: 727
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unexplained postnasal discharge...clear sinuses, no nasal/ nasopharyngeal pathology....hmm there is a remote possibility of a CSF leak. Did she ever have a history of trauma? even If not, there is a possibility of primary CSF leak that should be ruled out. I recommend u consult a good ent/ neurosurgeon. have an electrophoresis of the discharge done to confirm the nature of discharge. all the best.
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| fox
Forum Guru
Topics: 70
Posts: 727
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Does she have anosmia too?
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| som
Forum Guru
Topics: 59
Posts: 308
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for me this looks more like a case of allergy..how much d/c the pt has per day? are there any tests on the d/c like cytology or culture? is the pt on any meds on a daily basis?
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