Nasal septum perforation from OTC Nasacort

[cataraftirl]

I began cpap last August and started using OTC Nasacort last September for mild nasal stuffiness. In November, when the weather turned cold and I turned on my furnace, I started getting a dry painful nose, with hard crusts and bleeding. I increased the humidity & temp on my cpap machine, used saline sprays, Ayr saline gel, humidifiers, Xlear xylitol nasal spray, pretty much everything I could think of. It would improve some weeks, then worsen again. Last week I started to have a whistling in my nose. Then I blew my nose and this big hard brown plug of mucus with a perfect hole in it came out. I looked in my nose and saw a big hole. Yikes!!!!. I contacted my PCP, stopped the Nasacort, and saw an ENT today. Before I started the Nasacort, I rarely ever used any nasal sprays of any type. If I had a head cold, I used the Neilmed nasal rinse. Head colds for me happen 1-2 times a year. My nasal passages were well examined by my sleep doctor when I got worked up for the sleep apnea, and were examined by my PCP in October when I had a sinus infection. No perforation was seen then. NO....I do not now nor have I ever snorted cocaine, and I am not a chronic nose picker. The ENT has seen perforations in prolonged steroid spray use, but not in just 6 months. For now, treatment is saline rinses to keep my nose clean, and Bactroban ointment. I go back in a month. The ENT is hoping is will heal at least somewhat on it's own. He said that surgical repair isn't very successful, and most folks just live with it. It will not affect my ability to use my cpap, and was not caused by cpap. Through all of this, I have had not issues with cpap. It's still working great for me, and my AHI is 1 or below.

The ENT mentioned a nasal button as a possible treatment. has anyone heard of this? Any others out there who have had this problem? I guess OTC steroid nasal sprays are NOT 100% safe as they advertise.

[chunkyfrog]

Oh, heck no! Steroids of any kind are powerful drugs, capable of much good--and much danger if misused.
Otc are not as strong, but can be as hazardous as Rx strength, especially when used without an MD's supervision.

[Logies101]

Wow thanks for the warning on the Nasacort. Sorry you had to learn about it the hard way. Hope things get better for you.

[chunkyfrog]

The button actually sounds like an interesting, but removable solution.
Kind of like the space holders for those tribal ear holes.
Come to think of it, there might be an inexpensive alternative to the medical device!

[cataraftgirl]

I was using it under an MD supervision.

[chunkyfrog]

Sorry it wasn't a more competent MD.

[Tatooed Lady]

The button actually sounds like an interesting, but removable solution.
Kind of like the space holders for those tribal ear holes.
Come to think of it, there might be an inexpensive alternative to the medical device!

Or a place to hang your car key?

[chunkyfrog]

Not from the nose, though.
Maybe from a Prince Albert!
(We now have a reply to the classic nudist question)

[palerider]

Not from the nose, though.
Maybe from a Prince Albert!
(We now have a reply to the classic nudist question)

ob nudist colony joke:

who's the most popular guy at the nudist colony?

the one who can carry two mugs of coffee AND a dozen donuts!

[cataraftgirl]

Very competent MD. Short term use of nasal steroid sprays is supposed to be safe according to the ENT I saw today. This is the first case he's ever seen of this problem in short term use. He called another ENT from the practice in to look at my nose, and she's never heard of it either. He said it's rare even in long term use. But not 100% safe it appears. Then again, I'm a magnet for that sort of thing. Any weird side effect or rare risk from a surgery will happen to me.

Does anyone know anything about the nasal buttons, aside from the nose ring jokes?

[kteague]

Oh wow - sure hopes it does heal on its own. No knowledge about these things except hearing that long term use is not recommended. I've known people who use these even long term, and this is the first time I've heard of this happening. Thanks for telling your story as a warning.

[RandyJ]

Nasacort WAS a prescription drug at one time, I remember having a prescription for it, in the 80s I think. It was the "Nasonex" of its time... most of these drugs eventually transition to OTC, usually at same as prescription strength.

I've been using steroid sprays for almost 30 years with no issues. I think after Nasacort came Nasalide and Vancenase and Beconase and Flonase and probably another one I can't remember.

Nasonex has been working for me for several years now.

[49er]

Sorry it wasn't a more competent MD.

Actually, just because you have an adverse med reaction while under medical supervision doesn't mean the doctor was incompetent. No med is completely side effect free. The issue is does he take the patient concerns seriously and not blow them off and it sounds like this particular ENT definitely did everything right regarding this issue.

49er

[cataraftgirl]

I did some reading and from what I can tell, there was only one person who had a septal perforation during the clinical trials of Nasacort. Everything I've read lists this as a very rare side effect. Some of the literature says that a yearly exam of your nose is recommended if you use nasal steroid sprays long term. I know many people who have used them for years with no problems. My PCP (who is awesome and I trust) and the ENT I saw said that using a steroid spray for 6 months should have been safe. My symptoms started after just two months of using it. I didn't even think about the spray as the culprit. Since I was fine until winter started and I turned on my furnace, I just thought it was that. I turned up the humidity and temp on my cpap, and started to work on nasal moisturizing efforts. I'm a nurse, so I do know about how steroids work. But all the info I found on using the sprays was that they are safe. If you do use them, perhaps have a conversation with your Dr. and have your nose checked out at least once a year!

[cnaumann]

I used Nasonex seasonally for years. I started developing cataracts at age 45 and had corrective surgery at age 49. There is no way to prove it but I think there was a connection. The surgery turned out great an don't really have any regrets about using the steroids, but there take-away lesson is that steroids are very powerful drugs with many side effects. Don't let the OTC status of many of them fool you into thinking they are completely safe.