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Enlargement of nose and nasal space

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My Medications; Fluticosone Propionate, Salbutamol, Beclomethasone, Lotemax eye drops, Dermovate & Hydrous Ointment. (Prednisolone, & Nebuliser in the past).

Hello,

Over the last year my nose has been gradually increasing in size, it is now swollen significantly.
My nose has swollen by at least a third, internally it has become more spacious, and the nasal tip has softened and become rounded.
Recently when i explained my entire list of symptoms in detail to two online medical doctors (from the same site), the view of the first MD was that this sounds like chronic tissue inflammation due to some allergen such as pathogens, steroids, irritants or damaged cells. The second MD agreed adding that most likely 'cell growth caused by my steroid usage has caused the nasal enlargement'.
I'm sure these certified specialists know what they're talking about. I was unable to ask any follow-up questions on that site. If they have a point, i would like to ask you some questions related to this;

1)Does inflammation itself cause cell growth? (ie are both interconnected. I ask because these Drs' answers appear to contradict one another to a lay person like myself).

2)Is it the immune systems reaction to these things (ie an allergen or stimuli) that causes;
(a)The cell growth?
(b)Tissue inflammation?
And,
(c)Could an effectively functioning immune system reverse 'both' these things?

Please answer these questions regardless what your opinions are concerning the other MDs' answers.

Best Regards.

Category: Allergy and Immunologist

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Category: HIV- AIDS Specialist
 20 Doctors Online

Hello,

Thank you asking your query at DoctorSpring. With inputs from Dr.Deepu Sebin Sebastian.

Please allow me to answer your specific queries. You can ask followup/clarifications as a "followup question"

1. Yes inflammation can cause cell growth. Inflammatory mediators can be a stimuli for growth.

2. (a) Yes (but not the kind of reaction you are thinking of*)
(b) Yes

3. No **

--
*There is a fallacy in this 'immune system' concept. Let's take a simpler example - Consider an individual with no allergies or no immune system disorders. He works out at the Gym, his biceps grows in size. This is due to cell growth or hypertrophy. The reason for the growth is repeated stimulation and overuse of the muscle resulting in the hypertrophy. A part of this growth is actually mediated by a part of the immune system (other factors are also there). So technically it is an immune system reaction, but not the 'same' immune system reaction due to allergy.

So in your case - Allergen --> Immune system reaction ---> Allergy --> Symptoms -- > Increased blood flow, over use and stimulation (for example repeated nose blowing, rubbing) ---> hypertrophy.

**So regarding (QNO.3)if you have a good immune system your body will react better to allergen and hence there is chance for further hypertrophy.

Hope this helps
Please feel free to ask followups
Thank you
Dr.VV
Dr.DSS


Patient replied :

Dear Dr.DSS,

Thanks for that. I have several other questions related to this same subject matter;

1)I only have minor pain and redness of the nose from time to time. Is it not necessary for such symptoms (ie pain and redness) to be bad (or even present) for an individual who has chronic (or acute) tissue inflammation/hypertrophy of the nose?

2)The immune system isn't able to reverse the swelling as you mentioned, but can the elimination/avoidance of the specific allergen that is causing the hypertrophy do so? (ie reverse the tissue inflammation and growth)

3)If yes (to question 2), then what if the nasal cartilage has been affected by this tissue swelling, could they return back to their original shape after the swelling has gone?

4)Does an enlargement of the nose due to allergy (the type that i have) have a medical name or a simple term to describe the condition?

Thank you for your time.
Best Regards.





Hello, and thanks again for your queries. I will address your concerns the best I can.

1. During chronic inflammation as you are experiencing, it is not necessary for the redness and pain to be severe. In fact, inflammation is more severe in acute conditions. Chronically, the body adapts to conditions of inflammation to a certain level, that only mild inflammatory symptoms are present. On the other hand, hypertrophy becomes more prominent, as well as roomy nasal cavities due to atrophy, as your body adapts to chronic inflammation.

2. Eliminating allergens can halt the symptoms of rhinitis helping to reduce further damage and hypertrophy (as the repeated nose blowing and rubbing would cease as well). Unfortunately, this will not reverse the symptoms of atrophy and damage already done to the nasal septum and mucosa.


3. No. However, if the deformity is still present there are surgical options available to help to decrease the size of the nasal cavities. This is should be done if there is considerable drynss, crusting and discomfort in the nasal cavity due to increased air flow.

4. There is no name as such for the condition of a swollen nose due to allergies. If the symptoms are getting severe, such as if you notice bleeding through the nose (epistaxis), crusting, loss of smell then you should be consider the possibility of atrophic rhinitis. Another possible condition (considering the symptoms you have described) is a condition called rhinophyma in which the nose is enlarged due to granuloma formation causing deformity of the nose. Watch for signs of these other conditions and make an appointment with your local ENT specialist to address the issues if they come up.

I hope this answers your questions, and please feel free to update me with any future concerns or queries you have. Take care.


Patient replied :

Dear Dr. DSS, I think i may have the condition rhinophyma that you mentioned and undiagnosed rosacea (phymatous type) since a kid. I would like to ask you some questions before seeing the ENT Dr. 1)Is there an effective skin biopsy for rhinophyma? 2)During the early stages of my swelling i did actually see an ENT Dr. The only thing he did was insert a tube up my nostrils (with a mirror attached to the other end) and conclude that this is not a disease. Could rhinophyma be missed this way? 3)Could atopic eczema (which i have) co-exist with rosacea? 4)Please read my following symptoms (or lack of) and let me know if it could still be rhinophyma?; >I have no papules. >pink tip, not red. >i have a wider nose. >internally its more spacious. >more stretchier nose & >can now be pressed down close to the face level. Best Regards.


Admin Message -

Hello,
Your consult has been closed. Either you have utilized all 3 follow-up queries or your consult is now older than 1 month. If you have further queries, I request you to initiate a new consult. You could consult the same Doctor as well, please mention the same in the new consult with reference as 79267.

Hope this communication was fruitful. Wish you good health.

Thank you
In-house Physician
DoctorSpring.com


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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