Severe recurrent blocked nose after Covid

Iḿ someone who has experienced a blocked nasal airway (without any physical obstruction visible to ENT doctors) after COVID, against a backdrop of no history of sinusitis or any other disorder that would tend to produce an unrelenting impedance of air flow. COVID did not cause or leave me with any loss of senses of taste or smell.

Importantly, though, my health history already included a number of amorphous disorders by the time I got COVID, and over time, I have come to see my health history as relevant to the way in which long COVID has manifested in me. When doctors across a range of specialties could not help me, I set out to attempt to get well on my own, and now, 6 months post-acute COVID, Iḿ on a regime that may be starting to improve my condition.

Once I realized that I would have to take charge of my recovery, the first thing I did was to taper or discontinue any of the long-term-use medications I was on that could have increased my susceptibility to chronic upper respiratory congestion/airway blockage, under the supervision of my primary care doctor. It turned out that 3 separate medications I had been taking for anywhere from 3 months to 20 years were all well known for causing chronic nasal congestion as a side effect. To be sure, the tapers of these drugs, and search for their replacements, with my doctor, has been mighty challenging, but for me, there is no turning back on this measure.

Believing that my long-term medications were not the cause of the dramatic blockage I have been experiencing, even if they had made me vulnerable to congestion severity, but also sensing that the strange ailments I´ve experienced since childhood might indicate a lifelong underlying nutritional malabsorption syndrome, I was quickly led to learn that there is a cadre of long-COVID researchers who are noticing that the whole panoply of long COVID manifestations bear an uncanny resemblance to chronic (but subacute) thiamine/B1 deficiency (due either to malabsorption or under-consumption of foods rich in this vitamin). In the community that focuses on B1, the theme of neurological malfunction features prominently. Sure enough, my history included a diagnosis of dysautonomia. And thanks to the late Cleveland Clinic physician Derrick Lonsdale, there is now a large body of research and writing available on repletion of thiamine as a method for addressing the various disorders that cluster to form dysautonomia. After learning as much as I could about B1 repletion protocols, I started on a protocol which, in my case, has necessitated very, very slow and gradual B1 repletion. Two B1 protocols impress me the most, and these are the ones published by UK functional medicine practitioner Elliot Overton and the one that is popular among patients attempting to arrest their Parkinsonś Disease.

B1 repletion, if it is to work at all, can be a long journey, and so my next priority was to find non-pharmaceutical solutions (since a boatload of pharmaceuticals had only made me worse) that could improve my breathing as I await deeper change. I now have entire moving-storage containers of both pharmaceutical and herbal nasal sprays and systemic/oral nutraceuticals and herbs that I have tried, AT LENGTH, without success, but 6 months of intense trial and error have led me to a combination of items that seems to be giving me more hours each day of normal or nearly normal breathing through my nose. CAVEAT: I am not home free yet by any means, but I am finally getting hopeful. My palliative supplements follow, and nb.: At least one of these (NAC), in my view, is potentially not only palliative, but is, beyond that, possibly as deep-acting in resetting my nervous and respiratory systems as B1 may prove to be:

Proteolytic enzymes (serrapeptase, nattokinase, and combination proteolytics that include trypsin and chymotrypsin (which are in the same class of proteolytics as serrapeptase))

NAC (a precursor to glutathione shown, in a massive number of studies, to yield powerful antioxidant benefits; NAC has recently been lauded by long-COVID researchers at Yale Medical School who have documented their clinical findings that NAC seems to make a significant difference for long-haulers whose primary problems are fatigue and brain fog. I do not have those problems, but NAC is used even in orthodox medicine as a mucolytic, and so this feature alone has indicated its potential benefit for patients with both upper and lower respiratory congestion and blockages, not to mention that NAC is highly regarded, in the complementary medicine fields, as useful in depression and anxiety, which seems to develop in nearly all of us who are dealing with long COVID.)

Hydroxytyrosol (aka HXT) (an emerging antioxidant derived from olive oil that is currently in use by doctors in Italy who specialize in treating long COVID, and who have published favorable results in a small clinical trial with the use of HXT taken together with acetyl-l-carnitine and low-dose B complex)

Finally, because I have suffered from intermittent severe dry eye for over 25 years, I am borrowing an ophthalmic remedy that has often helped me, in hopes that it may finally provide moisture, albeit indirectly, for my truly dessicated nasal passages: Muro 128 hypertonic oinment. Muro ointment is my eye doctorś go-to for patients like me who have a history of mild recurrent corneal erosion, and so when I pause using it, I am reminded of how protective it can be for sensitive corneas. Since I cannot tolerate saline nasal sprays or any salve produced for topical use in nostrils (and these all make me worse), I am counting on the excess biological fluid drawn out of my corneas by the Muro ointment reaching my nasal passages via the distal opening of my nasolacrimal ducts, and, thereby, moisturizing my nose and warming the air that I breathe in. (To my delight, I think this may actually be working, at least a bit, as planned!)

In hopes of getting truly well again some time soon, I have also started walking very long distances every day, as I have a strong intuitive sense that COVID, when it met my dysautonomia and all of its component disorders, seriously weakened the effectiveness of all the neurotransmitters and hormones in my body somehow, making me feel that it can only help to keep trying to ¨raise my energy level up¨ in as many ways as possible. Very light aerobic exercise, like walking, turns out to be a perfect ¨sport¨ for a relative weakling like me. And for what it is worth, on the days when I bump into friends while walking, I forget about my breathing challenge for a while. Getting reminded of what itś like to feel normal definitely contributes to my motivation to keep striving.

Why do you prefer Muro ointment over Systane or Genteel?

Unlike Systane and Genteal ointments, which are petrolatum/mineral oil emollients designed simply to protect the corneas from contact-related stress (thereby soothing irritated dry eyes for a while), Muro is a much older petrolatum/mineral oil/lanolin/5% saline product designed, via its hypertonicity, to draw significant amounts of fluid out of waterlogged corneas. Corneas can get waterlogged as a reaction to ocular surgeries and in corneal diseases like Fuchs dystrophy, in which the basement membrane of the cornea doesn´t function optimally, allowing the corneal epithelium to loosen. Severe dry eye can also indirectly damage the corneal epithelium simply by virtue of inadequacy of the ocular tear film, leading to recurrent corneal erosion (especially during sleep). The salt concentration in Muro works wonderfully to tighten up loose/fragile corneal epithelium by drawing excess fluid out of the cornea regardless of the cause of this epithelial fragility. So Muro has traditionally been prescribed or recommended to dry eye patients who have recurrent corneal erosion, and for whom, therefore, blank ointments, like Systane/Genteel/Refresh P.M./Soothe, etc. will not be enough to prevent the recurring erosion. My recurrent corneal erosion is extremely mild, but my wonderful eye doctor opted to put me on Muro ointment long term because over time, stopping even a minor erosion cycle can greatly reduce corneal pain. Today, many different OTC eyedrops for dry eye are able to normalize some patients´ tear films (albeit temporarily), and so the prevailing treatment even for severe dry eye, other than the Rx products like Restasis, Xiidra, and varenicline nasal spray, are OTC drops like FreshKote (high oncotic pressure drops) and Optase MGD (with sacha inchi oil); and FreshKote, in particular, can normalize the tear filmś ability to wet the cornea so substantially that it is sometimes used in place of or together with Muro drops or ointment for dry eye patients with corneal erosions. In any case, Muro ointment has the potential to help me with my impaired nasal airflow by creating a pool of fluid from my slightly waterlogged corneas that then drains into my nasal passages after traveling through my nasolacrimal ducts. This fluid has the potential to moisten or humidify my severely dry post-COVID nasal passages, and if any of the saline and petrolatum base from Muro is also making its way into my nostrils, possibly these ingredients may provide their own, separate moisturizing effects. I cannot tolerate any nasal ointments or sprays (especially after months of wrecking my nasal passages with steroidal and antihistamine sprays loaded with preservative BAK), so the use of ophthalmic Muro as a less direct way of getting moisture into the nose seemed worth a try.

I appreciate your explanation. I wonder why my ophthalmologist has never mentioned Muro. I have dry eye and Salzman’s Nodules.

I have been seeing a cornea specialist at Duke for several years and before that with cornea specialist at UNC….I wonder why they never mentioned it. Just said use products without preservatives. I use ointment at night and lubricant drops during the day as needed.

I can’t use the prescription drops for dry eye. Just irritate my eyes.

I had a prescription for plasma drops, but haven’t gotten it filled, since my insurance doesn’t cover them.

Thank you, Celia, for sharing these details. I am unfamiliar with Salzmanś nodules, but just did a quick read about this disorder. I see that it is believed that dry eye (including the form caused by meibomian gland dysfunction) and infectious blepharitis can contribute to or trigger the disorder, and also that the nodules are associated with disruption of the corneal epithelium . . .Hmmm . . . I don´t know anything about the nature of this disruption, though, or whether it presents with swelling/waterlogging of the corneas, and so I cannot even guess whether it would be advisable, or even safe, to use something like Muro on your ocular surfaces in hopes of either alleviating symptoms or arresting the formation of nodules. I will say this, though, after 25 years of seeing a vast number of ophthalmologists and dry-eye-specializing optometrists: Many doctors are mentally locked into algorithms or protocols that they associate with particular diagnoses, and as treatment options expand and change, over time, older treatments that may actually have been effective, but which involved nonsurgical or inexpensive OTC products, are forgotten or become disfavored. When my eye doctor proposed Muro for me, I asked her whether it was really safe to use Muro off-label for dry eye (knowing, though, that before the most basic OTC drops for dry eye were ever invented, eye doctors ROUTINELY prescribed Muro to treat simple dry eye). My doctor assured me that I could use Muro safely even though I don´t have corneal dystrophy, and that the daily tightening-up of my corneal epithelium via Muro would be healthful and not harmful. So I will speculate here that the reason your specialists have not recommended Muro is because 1) Muro may never have been studied in relation to your disorder, 2) Muro has been deemed harmful or ineffective for your disorder, OR 3) Muro is considered, by many younger eye doctors especially, to be a sort of relic or outdated therapy even for the ocular surface diseases for which it was originally designed. If you approach your doctors about Muro, in any case, I would be very interested to learn the reaction you receive. In meantime, though, if you haven´t already done some online research into whether Muro has been studied in relation to your disorder, go ahead and explore that, as that will help you formulate the questions you pose to your eye doctors. Iḿ tempted to add one last gnawing thought here: Have you ever explored the possibility that Salzmanś nodules may be associated with (even if not causally) some particular nutritional deficiency? The sixteen different health issues I have dealt with, over my long lifetime, so far, have all, in peer-reviewed researching reporting, been associated with B1 deficiency (subacute), and yet not a single doctor I have ever seen has shown any interest in drawing any connection across my sixteen problems. They have not been looking for any unified cause for my health picture, and so treatment approaches have all been band-aids, often taking the form of powerful pharmaceuticals that have caused me secondary problems. These days, I am asking all the people Iḿ close to to consider whether any collection of maladies they´ve experienced may be connected by a unifying cause or sequence of causes, because I have become convinced that more of us have undetected and underdiagnosed nutritional deficits than is popularly believed. I see that Salzmanś nodules may be hereditary . . . but I would not let that stand in the way of exploring for nutritional connections nonetheless, because some nutritional deficiencies actually arise as a result of genetic glitches, and these deficiencies can often be remedied by steady nutrient replacement, even if the precipitating genetic glitch cannot be corrected.