Chronic Rhinitis

[TheRealMcCoy]

Hi guys,

I'll try to keep this as short as possible... Basically, since December 2013 I have been suffering from what appears to be chronic rhinitis. I have lived in Thailand for 5 years without anything worse than the occasional cold. However, around mid December I developed what I thought was a 'common cold' that has stuck with me until now.

I have been to 2 different hospitals. The first doctor at Sikarin Hospital thought I had an allergy and gave me some anti-histamines. The anti-histamines had zero effect on my symptoms and so I had a skin prick allergy test which came back negative. He then prescribed a nasal spray called Beconase, which again was pretty useless. I then went to Sukhumvit Hospital, where the doctor looked in my nose and throat told me they looked inflamed but was unsure as to why. She prescribed me a nasal spray called Avamys which has zero to minimal effect after 2 months of use.

My symptoms are a runny and congested nose, constant sniffing, plugged ears, blue/purple bags under eyes, red eyes, a mild sore throat and excess mucous. These symtoms are chronic or 24/7 and I can find no obvious trigger such as perfume, air con etc. The problem with the doctors I saw was that they seemed too keen to dish out medicine without properly investigating the root cause of the problem or indeed even suggesting what may be causing my symptoms.

I had a HIV test just to rule that out and a chest X-ray to rule out TB. I've heard there is a very good ENT doctor at Bumrumgrad called Dr. Prayuth. Aside from seeing him, does anyone have any other suggestions?

Thanks for your help, Cris

[h90]

Did you change your place of living when it started?

(just thinking you have something in the air....fungus, house dust mite, etc...not likely from what you told, but still worth to think about it).

[theguyfromanotherforum]

You are screwed.

I got something like that back in Canada although with a lot less symptoms than you. It eventually turned into Asthma.

Now doctors are really useless. You need to take care of it yourself. Find the triggers, comb the internet for any clues, join the forums, read, read, read.... and pray it does not turn into adult onset Asthma which is persistent and pretty dangerous.

Where do you live? I find Bangkok a very nasty place to live. Maybe moving to the beach will help. Exposure to sun (vitamin D) helps a lot in these cases.

[TheRealMcCoy]

Thanks a lot guys! I have not changed my place of living for the past 3 years. I live around On Nut. House dust mites is a possibility, although I tested negative on the allergy test and anti histamines don't help me at all. I plan to visit Rayong for a couple of days this week, so hoping the fresh air might help.

To be honest, I'm still shocked by the whole thing. To be feeling perfectly healthy and then suddenly develop a 'cold' that never goes away is bizarre. I've had colds and even tonsillitis in the past but they were always short term. This chronic rhinitis has been with me 24/7 for 8 months now and there seems to be no cure for it.

[h90]

yes sounds like it isn't an allergic....

Try a few days on the beach/sun maybe it helps?

[Kalbo]

Thanks a lot guys! I have not changed my place of living for the past 3 years. I live around On Nut. House dust mites is a possibility, although I tested negative on the allergy test and anti histamines don't help me at all. I plan to visit Rayong for a couple of days this week, so hoping the fresh air might help.

To be honest, I'm still shocked by the whole thing. To be feeling perfectly healthy and then suddenly develop a 'cold' that never goes away is bizarre. I've had colds and even tonsillitis in the past but they were always short term. This chronic rhinitis has been with me 24/7 for 8 months now and there seems to be no cure for it.

I have a terrible reaction to concrete-type dust that abounds during road and building construction in and around Bangkok. This may be a factor in your case. As to how to remedy it ..

sorry, but I don't have a clue.

[ammagic]

It could be a chronic sinus infection which requires long term antibiotics. And by long term I mean 3 months. Sometimes even a small amount of prednisone helps to reduce inflammation. Dr Prayuth is an excellent dr - I recommend you see him & do consider a ct scan

[Sheryl]

Agree that chronic sinusitis is a possibility. A consultation with a really good ENT is important...they vary widely in their expertise. I have had consistently good results with Prof. Songklot at St. Louis

[loppylugs1]

Take a swim in the sea.

[TheRealMcCoy]

I really appreciate the responses so far! I am considering all options/possibilities. I will head to Rayong this Friday and see how fresh air, sea and sun helps. I will also see both/either Dr. Prayuth at Bumrumgrad and Prof. Songklot at St. Louis. Chronic sinisitis is something I will mention to the docs and see if they recommend a CT scan. Many thanks, Chris

[Riverman63]

Beconese is available over the counter in UK for treatment of Hay Fever etc. it's been one of the few things to clear up my Hay Fever. It's not a strong drug but can make your mucus membrane a bit thin

[tfc]

When I was in the U.S. I had a form of rhinitus that wouldn't go away, my doctor prescribed Bronkaid which has ephedrine in it and it cleared up within 24 hours. These days I only get seasonal rhinitus and when I do I go to an ENT at a hospital to get prescribed something with pseudoephedrine in it. Actived or Clarinase or a generic. They all do the trick and often within the hour.

Tiffy used to solve the problem but since the ban on pseudoephedrine for sale outside hospitals the replacement ingredient phenylephrine does nothing. I actually talked to my Thai doctor about this and he confirmed that from his experience phenylephrine doesn't work for sinusitus or rhinitus.

[AlexRRR]

I have been diagonosed with rhinitis and it is chronic, I have been prescribed "Nasonex" and you can buy it over the counter in Thailand from about 600B, it works for me most of the time. ( takes about 2 weeks to kick in)

I have noticed that the Nasonex is limited to what it can do if i dont take some precautions, ive had it for years but only woke up to it when i was living in BKK, i got much worse living back in Melbourne on my return.

I get very tired feels like i have the flu coming on of course it isnt as it comes quickly and when its ready to go leaves as quickly as it came, light headed, inability to thing clearly, at one time i was put on aniti depressants, loose the desire to go to work go out, cant be bothered just sit around in a bit of a blurr, of course its not always like that, varies in degrees but before i got on to that spray i was feeling like crap around 60% of the time, sometimes sore ear and even cheek.

Clean is inportant, furniture, polished timber floors, carpet, paint give off vapers, i have to air my house over night every night, pollen, dust especialy in the dry weather getting blown around, even aircon can send me off, recall one bar i use to go had to stop as each time i would be crook for days after, old building and im pretty sure there aircon system hadnt been cleaned in years.

In India i checked into a hotel in Deli, within 10 min i had a splitting headacke followed with fatigue, then i realized the room was dirty, wiped my finger over a table top it had at least 3 weeks of dust on it, put my glasses on wow....filthy...needless to say i moved right out.

When i was told and prescribed my spray i used it for 3 months morning and night and for the first time in years i came alive, later i thought i could manage it, for one year i did not use the spray, i had some success tried salt room therapy ( they pump ground salt into a sealed room and you sit there for 45 min) helped but didnt cure me, a vaporiser was a big help but thats fine if your sitting in one spot all day, the minute a cold or virus comes along i was in trouble in the end i couldnt take it anymore for me its been 10 years of fighting i gave in and went back to that spray.

Im still peed off with my specialist doctor that he never truly made me understand what i was facing or my family doctor i had a history of seeing him over 4 or 5 ys on this issue, he never picked up on it, took me to work it out one afternoon when an attack came on sitting in Starbucks in BKK, armed with my ipad i did search apon search on allergys, i was shocked what i read, i had 95% of the symptoms.

For a while i use to put some vasiline in each nostral....works fine but make sure u clean it out each night, when i went back to work ( im in the building industry) it worked a treat no problems at work.

If you do have an allergy to dust etc you have for life now, there is no cure and little is known about the casues yet they do have some nasel spray that might work for you so you do need to see a specialist and do ask lots of qestions.

Edited August 27, 2014 by AlexRRR

[i claudius]

I had this for years ,even a specialist in the uk was useless ,then a doctor here told me to get a saline solution(farcino or boots about 45 baht) and every morning just squeese the solution up your nose to wash out each nostril ,you will soon get used to it ,i have never had the problem again ,the Indians use a neti pot,i think thats how you spell it ,you can google it ,its basically the same tratment cheap and very very effective.

[TheRealMcCoy]

Will try the neti pot and vaseline idea. Unfortunately, Beconese and decongestants haven't helped me at all though. Perhaps cleaning my room from top to bottom may help to rule out a dust related problem - although I tested negative on the allergy skin test anyway. I must stress that it is chronic, meaning every day for the last 8 months - not something that comes and goes. Thanks again!

[AlexRRR]

Will try the neti pot and vaseline idea. Unfortunately, Beconese and decongestants haven't helped me at all though. Perhaps cleaning my room from top to bottom may help to rule out a dust related problem - although I tested negative on the allergy skin test anyway. I must stress that it is chronic, meaning every day for the last 8 months - not something that comes and goes. Thanks again!

During that year i tried to manage my allergy i used a saline nasel flush daily as i said i had some success, once the packets ran out i used normal table salt, there is by "Fess" a nasel gel which helps too again sometimes yes sometimes no.

I know when i lived in BKK the first 3 months i was feeling great, later i moved about a kilometer up the road looking back my first apartment block was well managed and very clean also in a very nice and clean neighboor hood, the new condo block was a bit on the shabby side and it was obvious the clearner was lazy but hey it was 1/3 cheaper though i didnt know about my allergy then, not to long after my move i started to experiance that i cant be bothered to go out tonight feeling again, you know it comes on slowly, like a cloud that decends over you, you dont even realize your slipping backwards.

Dust, pollen, dirty aircon, dust/drit/pollen in the wind, many things inside the home especialy new give off vapors. Thai condos and houses are sealed, there is no air circulation stale air builds up, vapors, some people use air purifiers, there costly.

Get your self diagnosed first, change the air in ur condo or house often, stick to nasel flush and the gel, change your laundry powder, i use to run scented oil burner often, buy a vaporisor there cheap and run when ur home im pretty sure that will be your biggest help.

[AlexRRR]

The only worthwhile thing my specialst told me was that rhinitis is more likely to affect a human after a flu/virus from the ages of late 40s early 50s on, for you i dout it just happened more likley its been building for sometime, i didnt even realize my nose was blocked untill a sinus specilaist showed me on my exrays, he refered me on to that allergist.

Trust me if your chronic you will need an anithistmin married with finding the triggers and making changes, or your going to stay miserable for the rest of your life.

As a footnote, sea air....wonderful,, have a project on the coast 400m from an ocean beach i spend a few days each week here the freshness is amazing, there is a constant sea brezze over the project and the house i rent around the corner, with that in mind i had been keen to retire to Chaing Mai but now im thinking i should look for a place on the coast instead.

[mommysboy]

You mentioned Bumrungrad so I assume you are in Bangkok.. In which case, as other things have been ruled out, it is surely non allergic rhinitis caused by smog, pollution and the awful heat. Aircon can also be an antagoniser; should that be agonizer. The thing is it is a chronic condition, which also creates a bit of a vicious circle as your nasal membranes become very sensitive and never quite settle down, thus, just walking in to supermarket aircon can trigger a snot attack, and things that never bothered you much suddenly will. From your description I am guessing you have the works and would suggest the eye problem is a result of blocked tear ducts. It's usual to suffer sinus pain and bacterial infections of sorts.

I say this because I suffered exactly the same symptoms on and off when I lived in Bangkok for 10 years. Many of my friends did too, and the majority of us moved out this year as we suffered a great deal for some reason. Note it considerably worsened for all of us. We thought it might be the unusually hot weather and increased pollution.

I have been in Surat Thani for 1 month now, and surprise surprise I am completely free of symptoms. I still sneeze now and again, and get the occasional feeling of sinus pressure, but I would say I am cured. Like wise my friends.

So the only cure in imho is to get out, if this is too drastic then at least move to outskirts or take a few days break every couple of weeks,

Failing that finding a suitable antibiotic and pain killer will help a little, as will nasal rinsing. Make sure any aircon is working well and isn't harsh. Resting long periods of time may also alleviate the symptoms. But overall what you describe probably can't be treated as such.

If it is not smog, then you should have another allergy test, it has to be something after all and you really need to sort this out or you will become tired,and jaded sooner or later.

[mommysboy]

I forgot to ask, are there any building projects going on around you?, either small projects very close, or bigger ones in the neighbourhood. Your story reminds me of a bloke I met in Bangkok who described similar.

[TheRealMcCoy]

A friend recommended this forum to me. I have to say the comments so far have been more enlightening than talking to the doctors, and a heck of a lot cheaper too! I live in the On Nut area which is pretty built up and there is always some building project within 200 - 500 metres. I will be staying in Rayong this weekend (in a hotel which is supposed to be pretty remote.) I'm hoping the fresh air will do me good, although 2 days might not be long enough to tell. If not then I'll persevere with Avamys and the daily saline rinse etc and see a reputable ENT doctor for a diagnosis.

Aside from being sensitive to pollution or have a chronic sinus infection... Can these conditions be brought on my stress or diet? Also, has anyone had any experience with acupuncture?

Grateful for all replies, Cris

[AlexRRR]

Oh yes stress........the silent killer, manifests in oh so many ways, beats your imune system to a pulp if left unchecked, i did have a lot of it around the time i started getting my first attacks.

A number of things you can take to help inprove it like zinc, vit B but do be carful of that one, stingy nettle a herb can get in a tea or tablet is the best they say ( not sure about getting that in Thailand), like i said i tried many things.

I did say when i moved to a less cleaner part of BKK my allergy began to become an issue again but over all i found living in BKK better than living in Melbourne, here its very dry and that seems to inflame my sinus's way more than normal everyday polution of BKK.

One think with that saline wash it will dry out your nose do try that nasel gel it has eculptus oil in it.

It is very inportant to get digonosed, i spent a lot of money and a lot of time chasing fixes, in the end Nasonex spray and airing out my home every night while asleep, not driving with windows and sunroof open on windy spring and summer days, wearing face mask while doing dirty dusty work and keeping my house clean my life is somewhat normal again........If you have rhinitis you have it for life....no known cure.

Footnote...i have a dog, he is a very good companion but really i should give him up, pets are a no no if you suffer from an allergy, he use to sleep on the bed but for the last 18 months sleeps just out side of my bedroom. Cats and dogs leave bits of dry skin and hair everywhere so tiny you cant see the aircon or central heating just moves it around the house for you to breath, leaving a couple of windows open 20mm to get some sort of airflow seems to help.

[mommysboy]

A friend recommended this forum to me. I have to say the comments so far have been more enlightening than talking to the doctors, and a heck of a lot cheaper too! I live in the On Nut area which is pretty built up and there is always some building project within 200 - 500 metres. I will be staying in Rayong this weekend (in a hotel which is supposed to be pretty remote.) I'm hoping the fresh air will do me good, although 2 days might not be long enough to tell. If not then I'll persevere with Avamys and the daily saline rinse etc and see a reputable ENT doctor for a diagnosis.

Aside from being sensitive to pollution or have a chronic sinus infection... Can these conditions be brought on my stress or diet? Also, has anyone had any experience with acupuncture?

Grateful for all replies, Cris

No idea about acupuncture, but in my experience stress does antagonise all health issues.

The only cure is avoidance or less exposure imho. No magic bullet. This is because the body does not adjust to the situation, it'll just keep reacting whenever exposed. But the following medicines helped:

1. Nasonex (but can only be used now and again).

2. Beconase nasal spray, OTC medicine about 300bt.

3. Ponstan (for some reason). But follow guidelines assiduously.

4. Nasal rinsing with a saline solution.

5. Antibiotic (curiously doxycycline worked for me).

But medicines come with side effects and will only mitigate symptoms and in the end I ditched them all. I wouldn't go there.

Science in a nutshell : the main protagonist in city life is smog. This occurs when sunlight falls on ground ozone particles and pollutants such as building dust to create charged ions which fool the immune system in to making an immune response. There are also various toxic chemicals such as black carbon emitted by diesel engines which have an irritant effect. Sulphur is another problem, but more so in industrial cities.

I did find one ongoing rest cure in Bangkok towards the end of my stay. I chanced upon the basement floors of a Central shopping mall opposite Fortune Town. I used to sit at the donut joint. For some reason I noticed a considerable improvement in minutes and sometimes felt totally better after a couple of hours. A boff friend of mind explained to me that underground I was shielded from the smog and even better was breathing in negative ions of the sort by the ocean or at a waterfall or in the forest. It worked. Since you have had long periods of good health in Bangkok, you may just need to find a place like this or perhaps a spar or swimming pool.

If possible get out and about at night, as smog dissipates and less traffic.

It's quite intriguing that you should have developed this after so long. Generally, it either does effect you or doesn't. Any ideas yourself?

[TallGuyJohninBKK]

I really appreciate the responses so far! I am considering all options/possibilities. I will head to Rayong this Friday and see how fresh air, sea and sun helps. I will also see both/either Dr. Prayuth at Bumrumgrad and Prof. Songklot at St. Louis. Chronic sinisitis is something I will mention to the docs and see if they recommend a CT scan. Many thanks, Chris

I can sympathise with the OP....

Most of the ENT doctors here can look at your sinuses and tell you if you have some structural blockage or structural problem. And most can tell you if you have an obvious sinus infection. And you should at least have those issues assessed and/or ruled out.

But beyond that, for symptoms like yours (and mine) with no glaringly obvious cause, the ENT doctors seem to be pretty useless. And all you'll end up doing is running up medical bills and paying over-inflated hospital prices for medicines you can mostly buy over the counter yourself.

For example, I've yet to see any ENT here who suggested me to have any allergy tests done (even though I had them done on my own, because I wanted to know whether allergies likely were playing any role in my symptoms.).

I've seen both Dr. Songklot at St. Louis and Dr. Prayuth at Bumrungrad. Unlike Sheryl, I wasn't overly impressed with my visit to see Dr. Songklot, and in the end, he did little of any help. I had a somewhat better opinion of Dr. Prayuth, who seemed somewhat better at listening and discussing possible causes and different treatment options. Though lately, every time I've called to try to make a follow-up appointment, the ENT Department at Bumrungrad is saying Prayuth is fully booked, so you probably should plan for booking somewhat in advance.

But in the end, after ruling out structural problems or obvious infections, they all tend to play pretty much from the same playbook:

--pseudoephedrine tablets as a decongestant (which only can be obtained from the hospitals in Thailand now).

--some variety of anti-histamine tablets or spray to cut down on allergic reactions/inflamation.

--some variety of cortico-steroidal sprays to help reduce sinus inflammation.

The problem is, none of those medicines as a form of treatment alone do much to identify what's causing one's problem or do anything to stop the problem -- other than masking or reducing the symptoms. And various of the kinds of medicines mentioned above have potential side effects, particularly if used on a long-term, ongoing basis -- if you never get to the point of identifying what's actually causing your problem.

[inbangkok]

Tell your Dr. you want to try pseudophedrine. You have to get it from the hospital though.....no longer in pharmacies. Use in conjunction with the Avamy nasal spray. You might start feeling better. Especially if the anti histamines did not help.

[TallGuyJohninBKK]

Pseudoephedrine has been one of the more helpful, useful sinus medications I've ever taken over many years, and I've never had any apparent side effect problems with it.

Unfortunately, because of its potential for illegal use in the manufacture of meth, what used to be an over the counter medicine is now restricted to dispensing by hospitals, and that only happens as a result of a paid doctor's consultation.

Thus far, from the various ENTs I've seen here, they rarely seem inclined to prescribe more than 20 to 30 pills at a time (and I believe there are also some legal limits of how much of the drug it's legal to possess in Thailand, even with a prescription). But at the rate of two or three pills per day as recommended, that's enough to cover perhaps 10 days. The medicine itself is relatively inexpensive, perhaps 100 to 150 baht for 20 tablets, depending on the prescribing hospital. But then you can figure to add in an extra 500 to 1000 for the outpatient doctor's appointment every time to need to renew your supply.

On my most recent visit to BNH, another ENT there who I have a generally good opinion of, Dr. Pasakorn, prescribed, along with pseudoephedrine, a different antihistamine that I'd never used or had prescribed before -- known here as Aerius 5mg tablets, but which is known in the U.S. as Clarinex / desloratadine. That is the newer version of a similar drug, loratadine, that is marketed as Claritin. Both have potential side effects.

The Wiki entry for desloratidine cites one study to say: "Unlike other antihistamines, desloratadine is also effective in relieving nasal congestion, particularly in patients with allergic rhinitis." So if that's true, perhaps it could serve as somewhat of a replacement for pseudoephedrine. Both loratadine and desloratidine are available over the counter in Thailand, unlike pseudoephedrine.

The combination of those two pills along with a short-term use spray -- Iliadin, which is a brand of Oxymetazoline, a topical decongestant probably best known elsewhere under the brand name Afrin -- helped resolve my most recent sinus flareup. The Iliadin spray is only recommended for very short-term use, no more than three days at a time. But at least for me, it seemed very effective and fast-acting in terms of opening up my sinuses. Iliadin also is available over the counter here.

[TallGuyJohninBKK]

So, outside of doctor's visits and medications, I should mention and reinforce the various self-help things relating to sinus problems:

--getting adequate rest and hydration, but avoiding caffeine.

--sinus steaming with some added kind of clearing agent like pure eucalyptus oil (a few drops) added to the boiling/heated water.

--sinus rinsing with a low-level saline and baking soda solution using a netipot or other similar device irrigation device. There are sinus squeeze bottles that can perform the same function, but I use a WaterPik teeth cleaning unit with a special sinus tip for my nasal irrigation.

--removing potential irritants from your home environment -- making sure air con units are regularly cleaned and the filters cleaned even more often; avoiding carpeting and pets, encasing pillows and mattresses in dust-mite proof covers. Some people are allergic to feather pillows and should use non-allergic fillings instead. Some people also use electric air cleaner units in their bedrooms. Though some types of those -- ones with electrostatic precipitators -- also produce ozone, which is a respiratory irritant and best to be avoided.

[mommysboy]

Some good postings. Tall Guy John, just one thing though you say no obvious cause, but surely there is- the rotten air?

[TheRealMcCoy]

Once again, some really useful comments! I will try to follow up on the pseudoepherine tips. I have now started using the saline nasal rinse daily combined with Avamys nasal spray. No improvements yet but I'm trying to stay positive, especially if I can see Dr. Prayuth and get hold of some pseudoepherine. I spent the weekend just outside Rayong so got plenty of fresh air and relaxation. I did notice a slight improvement in my symptoms, although it's hard to say whether it was due to the fresh air or just feeling stress free on holiday.

As I mentioned before, it's hard to find an obvious trigger for my symptoms. I've heard other people say they get a runny nose from air con, perfume, cigarette smoke, car exhaust or spicy food etc. Having never suffered from any symptoms despite living in Bangkok since 2008, I feel somewhat perplexed. I have never had an allergy in my life or asthma. I should mention that my symptoms seem to change every few weeks. For example, I used to suffer from post nasal drip and a sore throat. However, more recently my main symptoms are headache and plugged ears. There is no ear pain, but my hearing is diminished and I can feel/hear my own pulse in my headache and ears (kind of like when you put a seashell to your ear.)

The only significant recent change I made was to join a gym in September of last year. I now exercise 3 times a week and use a sauna and steam room as well. I imagine this is probably irrelevant but it's the only thing that sprang to mind in terms of lifestyle changes. I am 31 years old and my general health is fine with the exception of high cholesterol.

I am really grateful to all the people who take time out to comment and offer support and suggestions! To be frank, I was starting to get frustrated and depressed after 8 months of symptoms with no respite despite visiting 3 doctors and trying various kinds of medicine. I just want to get my normal life back! (I'm sure some of you know how I feel.)

Edited September 1, 2014 by TheRealMcCoy

[TallGuyJohninBKK]

The post-nasal drip and the sore throat are common companions... The gunk runs down the back of your throat and irritates the tissue there.

FWIW, in my most recent flareup, I had a lot of congestion feeling in my ears and a severe headache on just one side of my head that would begin shortly after when I would lay down at night. If I stayed upright, no headache symptoms. Regarding the nigh-time headache, never experienced anything like that before, and the various doctors I saw were little help.

But in the end, the combination of pseudo, the nasal sprays and some other stuff, including steaming and rinsing, finally saw it subside.

[mommysboy]

Once again, some really useful comments! I will try to follow up on the pseudoepherine tips. I have now started using the saline nasal rinse daily combined with Avamys nasal spray. No improvements yet but I'm trying to stay positive, especially if I can see Dr. Prayuth and get hold of some pseudoepherine. I spent the weekend just outside Rayong so got plenty of fresh air and relaxation. I did notice a slight improvement in my symptoms, although it's hard to say whether it was due to the fresh air or just feeling stress free on holiday.

As I mentioned before, it's hard to find an obvious trigger for my symptoms. I've heard other people say they get a runny nose from air con, perfume, cigarette smoke, car exhaust or spicy food etc. Having never suffered from any symptoms despite living in Bangkok since 2008, I feel somewhat perplexed. I have never had an allergy in my life or asthma. I should mention that my symptoms seem to change every few weeks. For example, I used to suffer from post nasal drip and a sore throat. However, more recently my main symptoms are headache and plugged ears. There is no ear pain, but my hearing is diminished and I can feel/hear my own pulse in my headache and ears (kind of like when you put a seashell to your ear.)

The only significant recent change I made was to join a gym in September of last year. I now exercise 3 times a week and use a sauna and steam room as well. I imagine this is probably irrelevant but it's the only thing that sprang to mind in terms of lifestyle changes. I am 31 years old and my general health is fine with the exception of high cholesterol.

I am really grateful to all the people who take time out to comment and offer support and suggestions! To be frank, I was starting to get frustrated and depressed after 8 months of symptoms with no respite despite visiting 3 doctors and trying various kinds of medicine. I just want to get my normal life back! (I'm sure some of you know how I feel.)

Don't know if I can shed any more light on this other than to recount exactly the same symptoms over many years off and on, with different parts of The URT being effected at different times. The symptoms will subside but will likely recur in some form or another. The ear problem is most likely a middle ear infection more disturbing than dangerous, or perhaps a build up of wax. The headache most likely sinus headache caused by pressure, and perhaps dehydration is a factor. I think you need to go to a doctor and he/she will probably prescribe a course of antibiotics. Most likely your symptoms will gradually lift and you may be able to disseminate what is causing what.

Thinking about it, my wife who previously was only marginally effected by the Bangkok air started to develop marked symptoms over our last few months in Bangkok. Since she'd recently fallen pregnant I put it down to that.

And recently a Danish friend of mine who has lived here for 4 years started to develop nasal symptoms eventually ending in hospital treatment. He never suffered an allergy before.

So what with your story, I am wondering perhaps something has worsened in Bangkok !. So much building work going on.

I know with toxins the body can reach a saturation point, and literally one can start exhibiting strong symptoms over night. Perhaps with some aspect in your life you reached a tipping point.

Living in Surat Thani around the fresh air I have had one month symptom free and that is probably more than I ever had in Bangers all the time I was there. I got a cold over the weekend. in bangkok, that would signal a tortuous few days for me, going even so far as coughing fits and vomiting, I feel recovered already. So it seems rather obvious to me that the cause is pollution, and equally obvious that the only cure lies in some form of relocation. I greatly miss Bangkok I must admit so I understand it may not even be a consideration for you, but a change of property perhaps to the outskirts is surely not so terrible.

It would be good if you could tip the balance back to being not so effected. Not all people are so obviously prone and as I said before, it could be something very local like a big building project.

2 weeks away would be useful if you can work it in.