<s>[INST] Hello doctor, My nose is blocked partly, one side is opened and the other side is blocked. It has been a long time like more than 10 years. When I consulted a doctor before they concluded that it is allergic rhinitis. I sneeze multiple times in one shot, like three to four times. When I consulted another doctor, they asked to get an x-ray of my nose and concluded that bones of the nose are not straight, so it needs an operation. Some doctors said it is polyp that needs to be removed. I did not do any operation, because I heard that it is better to treat without any operation. Now it is still blocked with itching and I sneeze several times. What is your advise? What I should do? [/INST] Hello. Let us look at your problems in a systematic way. Nose block on and off and on different sides each time sounds more like a rhinitis problem. If it were deviated nasal septum then the block will be predominantly on one side. Such a block will not be that easily relieved. Deviated nasal septum if diagnosed and causes a severe block, snoring, mouth breathing and difficulties can be surgically corrected and placed in the center. Allergic rhinitis can cause multiple sneezing, itching of nose and eyes, watering of eyes and nose block. The rhinitis can cause itching in the back of the throat and palate also. Allergic rhinitis is a genetic condition that does not have a complete cure. We advise allergen avoidance, taking antihistaminics and steroid nasal sprays. Last, nasal polyposis can be associated with allergy and sinusitis. They cause constant nose block and nasal discharge. They cause post nasal drip. Occasional or frequent headaches, especially in the facial region or brow region, are associated with polyps. Polyps if found to be of higher grades require surgical correction. Coming to the diagnosis of each problem, we need to do the following on you. 1. A thorough clinical examination with anterior rhinoscopy. 2. Nasal endoscopy in OPD (out patient department), which will clearly show deviation or polyposis. Nasal endoscopy is done after adequate local anesthesia and decongestion. It typically is painless most of the time. 3. Non-contrast CT (computed tomography) scan of para nasal sinuses (coronal, axial and sagittal views). The CT is a superior investigation to x-rays and clearly shows the involvement of sinuses, the existence of polyps or sinonasal pathology, deviation of the nasal septum, condition of the lateral wall of the nose, mass in the nasopharynx, etc. 4. Serum IgE (immunoglobulin E), elevated levels signify atopy or allergy. 5. Complete blood count inclusive of but not restricted to absolute eosinophil count. I trust you understand that there are clear treatment protocols for various conditions. Not all conditions can be cured by medicines alone and not all can be done by surgeries alone. Some nasal pathologies will require medical and surgical methods for adequate relief. If there are any reports from previous ENT doctor visits please attach those in the next query. This will help us unnecessarily repeat investigations and help us diagnose faster. Do attach the x-ray film as well as report in the next query. We do obtain some relevant information from x-rays which we can use here. Until we come out with a clear diagnosis and treatment plan, I would suggest you start on Mometasone spray two puff twice daily and tablet Allegra M once daily. If I were to get a patient in my OPD with these complaints I would give these medicines that I mentioned above. Do revert back so that we can help you. </s>