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Extremely Painful Bridge of Nose
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raculara posted:
Hi - I'm hoping someone can shed some light on my problem. I'm a 33 yr old female. About 3 years ago I woke up feeling like someone had punched me in the nose right where the hard part of your nose meets the soft part, on the right side of the bridge. I had slight swelling, slight redness and pain when breathing in. I went to an ENT who could not figure out what was wrong. He prescribed a nasal spray which made it worse and then a zpack. It didn't seem to get better so eventually I just started coating the inside of my nose with Vaseline and eventually it went away. Over the years it has felt slightly tender on and off but nothing more developed. This past Sunday, however, it came back. Same place. I went to another ENT on Monday who looked inside my nose and said it was a little redder on right side than on the left but he did not see any pus, blocked follicles or lesions. He said he thought it could be staph or MRSA but since there was no pus there was nothing to culture. He put me on 150 mg of Clindamycin, 4x a day for 10 days and Bactroban which I put inside both nostrils. I went to my dermatologist the following day as it seemed to be a deep skin problem and not an internal problem in my nostril. He assured me he didn't think it was staph or MRSA because he sees a lot of staph and I didn't have the type of swelling or redness usually associated with it. He thought that taking the antibiotics was a good idea just in case. He did not know what it was though. It is extremely painful to the touch. I know that it is not broken and I was not hit in the nose. The redness and swelling have subsided some but my nose is running on and off, all clear fluid, I am sneezing occasionally, my skin feels tight and my eyes are itching. I haven't gotten to the stage where it hurts to breathe in yet. I'm hoping that since I immediately got on antibiotics and Bactroban it will knock this out before it gets to that point. What worries me though is that the ENT thought it was staph or MRSA and it being so close to my brain. I think what may have caused it was using my nail to clean out my nostril. I may have knicked it and caused an infection. I'm very worried but I don't want to run off to the ER if all they are going to tell me is that I need to keep taking my meds. I have not had a fever, so that's good. I noticed today that the pain is lessened in the original spot and now there is a general pain that is spreading from the right side to the middle of the bridge of my nose. The general pain is just slightly sore as opposed to extremely painful. When I had it 3 years ago it spread to both sides of my nose before it finally went away. My question is, what the heck is this? Is it facial cellulitis, MRSA, sinusitis, or just some inexplicable inflammation? I'm especially worried because I have a 5 month old son and if it's MRSA I don't want him to get it. The ENT told me just to wash my hands often and not share towels. If it is MRSA are the antibiotics going to knock it out or should I see a Infectious Disease doctor to determine if it is in fact MRSA? I'm just at a loss since one doc told me one thing and the other said he highly doubted it was MRSA. Any advice/help would be appreciated!
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Rod Moser, PA, PhD responded:
Without the ability to examine you first-hand and review your complete medical history, it would not be possible for me to blindly answer most of your patient-specific questions. A description -- no matter how thorough -- is not a substitute for an examination.

MRSA is possible, but I would really have no idea if you have it or not. A culture would have been nice before starting those medications but most community-acquired MRSA (if you did have it) would respond to the clindamycin and the Bactroban. If sinusitis is a clinical consideration, a sinus CT scan would offer some valuable information since it can see sinuses that are not easily viewed on examination, like the Ethmoid sinuses on each side of your nose. As you know, doctors are like chefs....so they all "cook" a bit differently. The dermatologist doubts you have MRSA. Facial cellulitis would have been clinically evident on examination.

Make a follow up with the ENT so that he/she can go the next diagnostic step if your current treatment is not helpful.
 
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Rod Moser, PA, PhD replied to Rod Moser, PA, PhD's response:
Now, I am not making a diagnosis here, but here is a medical article for you to read about another diagnostic consideration....

http://emedicine.medscape.com/article/331475-overview
 
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raculara replied to Rod Moser, PA, PhD's response:
Thank you so much for your response. I will talk to my doctor about recurring polychondritis. I have been reading up on it, and while the only symptom I have is the nose pain, it is still a possibility.

I have been on the antibiotics since Monday. On Thursday the pain on the right side was significantly better but the pain had move to the middle of my nose. It was only slightly sore. Last night and today the top of my nose is very sore and now the left side is hurting. The right side is completely pain free. I will say that my 5 month old son hit me in the nose which could account for the significant increase in pain. I vaguely remember this is what happened last time sans being popped in the nose. Started on the right, moved to the middle and ended on the left. My questions are:

1. If it were MRSA or staph, would the infection move around like that?
2. If it is recurring polychondritis, what type of doctor should I see. I was discouraged to see that most people go to 5 different doctors before being diagnosed.

Thank you!
 
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Rod Moser, PA, PhD replied to raculara's response:
MRSA or the gardenp-variety of Staph tends to be not only painful, but RED and HOT, so if you don't look like Rudolph, chances are this is not an infectious process, but an inflammatory process.

An ENT is probably your best best to get properly diagnosed, but if you can see an ENT associated with a largey, university-based medical center ENT department, you can take advantage of their collaborative medical resources. You may see five ENTs, but they should all be in the same place....
 
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raculara replied to Rod Moser, PA, PhD's response:
Thank you Dr Moser. I really appreciate you taking the time to answer my questions!
 
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bstinga replied to raculara's response:
Hi raculara and Dr. Moser,
I am having the EXACT same symptoms and Google brought me to your post. The pain started on the right side of my nose, migrated to the top of the bridge, and is now moving to the left side of the bridge. All within the past 3-4 days.
Were you ever able to get an accurate diagnosis?
I thought I may have hit my nose in my sleep or otherwise, but the fact that the point of most sensitivity is actually migrating across my face tells me it's something else.
Thanks for your feedback!!

-Brian
 
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Rod Moser, PA, PhD replied to bstinga's response:
Brian, get in to see an ENT so you can be properly examined and diagnosed. Similar symptoms in two different people do not always imply identical diagnoses. Besides, when you are diagnosed, likely you will need some patient-specific treatment.
 
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knockoutroses76 replied to bstinga's response:
Same symptoms as you. After 8 days of agony, finally went and got diagnosed with cellulitis. Was prescribed with Bactrim yesterday and feel 90% better today! However, looking on the internet for a self diagnosis is scary. That's actually what made me take it seriously and finally get checked out. I would recommend that you go straight to your primary before consulting the internet.
 
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Rod Moser, PA, PhD replied to knockoutroses76's response:
I absolutely agree...thanks for your input
 
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Alex69 replied to bstinga's response:
Hell raculara and bstinga,


I was wondering if there was any update on your final findings on your condition. I also have the exact same condition: In the last week the pain started on the right side of my nose, near the bony part, migrated to the top of the bridge first, then to the left side, where it is sitting right now. I can breath through my nose, there is no discharge or redness, but a tiny bit of swelling. One difference from you guys is that I already went to my primary care physician who put me on antibiotics. I tried 4 days of dicloxacillin without any improvement and he has now switched to cephalexin, which I have been taking for only one day, and didn't notice any improvement, yet.


I was wondering if Dr. Moser had an answer to a previous question: would staph or MRSA move around like that?


Also, should I be worried about the infection spreading to my eye and/or brain?


raculara and bstinga, how did you solve your condition?

Thanks!
 
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Rod Moser, PA, PhD replied to Alex69's response:
MRSA can definitely be colonized in the nose, and it can cause abscesses and seed infections in other areas (since we rub our noses quite often). Did your doctor culture your nose to see if you did have MRSA? Plain old Staph is more common in the nose.

Can it spread to your eye or brain? Yes, but thankfully, this rarely happens if it is properly treated.
 
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Alex69 replied to Rod Moser, PA, PhD's response:
Dr Moser,

Thank you for your reply. Unfortunately, my doctor did not culture the nose, but upon inspection, he thought that it was more of a superficial skin thing rather than an inside the nose one. Anyway, it looks like Cephalexin is finally working. It took it a few days before I could feel the effects, but now, on day 4, the pain has almost completely recessed. I am still a bit puzzled about what really happened, but I am glad that it appears resolved. thanks!
 
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Rod Moser, PA, PhD replied to Alex69's response:
We have this saying in medicine: Gone is Good. If your medical is resolving on medication or just naturally, we feel this is good!
 
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fleur_0 replied to Rod Moser, PA, PhD's response:
Good morning Dr. Moser. I came across this thread last night looking for ideas on what could be wrong with my nose. The information you provided was very interesting.

I caught a cold a week and a half ago that seemed to be going away. But then a few days ago the bridge of my nose started hurting. It isn't the skin or the interior of my nasal passages. My breathing isn't compromised. It feels like I should have a bad bruise, like I got socked in the nose. But aside from a bit of swelling there are no other visible symptoms. And the pain and swelling is isolated to the bridge of my nose.

I figure that if it persists through the weekend I'll get a referral to a physical ENT.

My question to you is this... Can a person simply have nasal chondritis without it being relapsing polychondritis?


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