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 warm weather and cold, whether I’m inside or out. I’ve had this problem for years and it is embarrassing. Is there anything I can do?

Jess Webster, Dundee.

Having a constantly dripping nose is a common problem, affecting around one person in ten. It is known medically as chronic rhinitis and there will often be persistent sneezing and a blocked feeling in the nasal passages, too.

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 something else is at the root of it.

In your longer letter, you say you have had the problem since your mid-30s (you are now 70) and that you have tried various allergy-suppressant medications (tablets or nasal sprays) but they made no difference.

This makes me think that you have chronic — i.e. persistent — non-allergic rhinitis. In this case, the endless runny nose results from irritation of the nasal lining, a spongy membrane that has a prodigious population of mucus-secreting cells (as well as tiny blood vessels).

For unexplained reasons, the lining can become overly sensitive to a range of chemical and physical factors, including a drop in temperature, dry air, pollution, stress, spicy foods and even perfume. This triggers the mucus-secreting cells into action, leading to spontaneous streaming.

I like the term ‘irritable nose syndrome’, as it neatly encompasses what’s going on here.

Hormones can play a part: menopause, pregnancy and oral contraceptives can all encourage rhinitis, as can a number of other drugs, such as ACE inhibitors and beta-blockers used to treat high blood pressure, and certain medicines used for erectile dysfunction and depression.

One possible explanation is that the mechanisms controlling the flow of blood to the lining of the nasal passages are over-sensitive — so with little or no provocation, more blood flows there, which encourages a blocked-up sensation and triggers the cells in the nasal lining to produce mucus.

I regret to say there is no cure. I must also caution against excessive use of over-the-counter nasal decongestant sprays. Although they may be briefly helpful, there is always a rebound effect, with worse symptoms if they are used continuously for more than a week or two.

Similarly, corticosteroid nasal sprays can cause problems if used long-term; while the drugs reduce inflammation, they can lead to atrophy (irreversible thinning) of the nasal lining, which ultimately causes excessive dryness and discomfort (a condition called atrophic rhinitis).

Hormones can play a part: menopause, pregnancy and oral contraceptives can all encourage rhinitis. [File image] 

There is one antihistamine spray, azelastine (taken twice a day) which can prove helpful for your type of rhinitis, possibly due to its anti-inflammatory effect rather than specifically its anti-allergy effect. Your GP may agree to prescribe this for you.

You can also ask them about 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 on an intermittent basis — i.e. in circumstances that you know trigger a runny nose — and may be helpful in offering you some relief.

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

Margaret Mullinger, Somerset.

Balancing the pros and cons of surgery is an issue that will affect all readers, so thank you for your letter. In your case, I’m happy to say there will be a lot of pros — in that mobility and pain should be improved — and very few cons.

You say in your longer letter that you have thrombocytopenia, an auto-immune condition in which the body starts attacking platelets — tiny cells within the blood that are vital for clotting — or doesn’t produce enough of them. When you are injured, platelets stick together to form a plug to seal the wound.

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

Treatment options include steroids or immunosuppressants such as mycophenolate and azathioprine, which work by reducing the immune response that is causing 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 the attack on platelets).

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

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

It is true that a hip replacement operation causes some damage to the bone of the pelvis in order to implant a new socket, which creates a bearing surface for the replacement hip joint. This will inevitably have a small disruptive effect on the bone marrow at the site, where platelets are made.

However, let me reassure you that the operation won’t have any effect on the remainder of the bone marrow throughout your skeleton, or significantly harm your platelet production.

Given that your right hip is arthritic and painful, my advice is that you should go ahead with the operation. 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 — include contact details. Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context. Consult your own GP with any health worries.