Dr Martin Scurr: Why have I had a runny nose for 30 years – and what can I do to make it stop?

My nose drips all year round – summer and winter, in hot and cold weather, whether I’m indoors or out. I’ve had this problem for years and it’s embarrassing. Is there anything I can do?

Jess Webster, Dundee.

Having a constantly dripping nose is a common problem, affecting about one in ten people. It is medically known as chronic rhinitis and there will often be persistent sneezing and a stuffy feeling in the nasal passages as well.

It can be seasonal or felt all year round, and more often than not it is caused by an allergy. But in your case I think there is something else at the root.

In your longer letter, you say you’ve had the problem since your mid-thirties (you’re now 70) and that you’ve tried various allergy-suppressing medications (tablets or nasal sprays) but they made no difference.

This makes me think you have chronic – ie persistent – non-allergic rhinitis. In this case, the endless runny nose is due to irritation of the nasal lining, a spongy membrane that contains a prodigious population of mucus-secreting cells (as well as small blood vessels).

Inexplicably, the liner can become hypersensitive to a range of chemical and physical factors, including temperature drop, dry air, pollution, stress, spicy foods, and even perfume. This sets the mucus-secreting cells into action, leading to spontaneous streaming.

I like the term “irritable nose syndrome” because it neatly encapsulates what’s going on here.

Hormones may play a role: Menopause, pregnancy, and oral contraceptives can all promote rhinitis, as can a number of other drugs, such as ACE inhibitors and beta blockers used to treat high blood pressure, and certain drugs used for erectile dysfunction and depression.

One possible explanation is that the mechanisms that control blood flow to the lining of the nasal passages are hypersensitive – so with little or no provocation, more blood flows there, promoting a feeling of congestion and activating the cells in the nose. lining to produce mucus.

I’m sorry to say there is no cure. I must also warn against overuse of over the counter nasal sprays. While they can be useful for a short time, there is always a rebound effect, with worse symptoms if used continuously for more than a week or two.

Similarly, corticosteroid nasal sprays can cause problems with prolonged use; while the drugs reduce inflammation, they can lead to atrophy (irreversible thinning) of the nasal lining, eventually causing excessive dryness and discomfort (a condition called atrophic rhinitis).

Hormones may play a role: menopause, pregnancy, and oral contraceptives can all contribute to rhinitis. [File image]

There is one antihistamine spray, azelastine (taken twice a day), that may be helpful for your type of rhinitis, possibly for its anti-inflammatory effect rather than specifically the anti-allergy effect. Your doctor may prescribe this for you.

You can also ask them for a prescription for ipratropium – the best results I’ve seen for your type of rhinitis are with this nasal spray. It works by drying nasal secretions and should be used intermittently – that is, in conditions you know cause a runny nose – and may be helpful in giving you some relief.

My right hip is arthritic and painful and I have been recommended a hip replacement procedure. But I also have a low platelet count. Should I continue with the operation?

Margaret Mullinger, Somerset.

Weighing the pros and cons of surgery is a matter that will concern all readers, so thank you for your letter. In your case, I’m happy to say there will be many benefits – in that mobility and pain should be improved – and very few drawbacks.

You say in your longer letter that you have thrombocytopenia, an autoimmune disease in which the body begins to attack platelets — small cells in the blood that are vital for clotting — or doesn’t produce enough of them. When you’re injured, platelets stick together and form a plug to seal the wound.

A normal platelet count is between 150,000 and 450,000 platelets per microliter of blood. With thrombocytopenia, levels can drop to 20,000, causing symptoms such as multiple small bruises, bleeding gums, or nosebleeds.

Treatment options include steroids or immunosuppressants such as mycophenolate and azathioprine, which work by reducing the immune response that triggers the attack on platelet production. Alternatively, patients may be offered surgery to remove the spleen (part of the immune system that may be involved in attacking platelets).

Hip replacement surgery causes some damage to the bone of the pelvis to implant a new socket, which creates a bearing surface for the replacement hip joint. [File image]

More recently, medications such as eltrombopag (a daily pill) that stimulate the receptors involved in platelet production have been shown to be effective.

Admittedly, hip replacement surgery does cause some damage to the bone of the pelvis to implant a new socket, creating a bearing surface for the replacement hip joint. This will inevitably have a small disruptive effect on the bone marrow where platelets are made.

However, I can assure you that the surgery will not have any effect on the rest of the bone marrow throughout your skeleton, or significantly impair your platelet production.

Since your right hip is arthritic and painful, my advice is to go ahead with the surgery. It is a safe and effective way to relieve chronic pain and restore your mobility.

Write to Dr. Scurr

Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London W8 5HY, or email: drmartin@dailymail.co.uk — add contact details. Dr. Scurr cannot respond to personal correspondence. Answers should be taken in a general context. In case of health problems, consult your own doctor.