Natto. Literally the worst, IMO. Even a good number of Japanese folks don't like it.

I'm sure the overall reason is stochastic, with other concurrent contributing factors, but writing off what is generally considered to be the main reason for an acute change in educational metrics (which coincides pretty spot on with am abrupt interruption in home life and school life) doesnt seem reasonable. I haven't heard anything besides the pandemic, being the main driving force for the acute change in educational metrics. Raising a child and reading to them is different than directed education. I value the time I have with my children and read to them daily. This is very different (but complimentary to) than what they would get at some sort of structured pre-k.

This is one of those situations if your looking at the "why," you have to use judgment. All of the data is of course, retrospective, which is not as good as a prospective stuff such as a randomized controlled trial (which it would, of course be unethical to perform). When thinking about stuff like this, I like to point people out to a peer-reviewed systematic review that shows parachute is not associated with survival when jumping out of airplanes (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/). The point is, we can't always clinically study some thing in the best possible way because it's either impractical or unethical, and sometimes you just have to use your best judgement unless/until something more concrete comes to light. We cannot, ethically, do an experiment where we recreate many of the conditions at the start of the pandemic and to conduct an RCT that this drastically affect education (including early education and development).

That being said, I do agree that we should do what we can as parents to raise them, read, help educate, teach good life skills and help instill positive personality traits. I do agree that screen time, distractions, and overall pace of life have been a contributing factor to this for many years, and no-doubt, have played a role at least in the background during this acute decline.

I'm sorry, this seems a bit disconnected with the reality of actively working and simultaneously taking care of children. If you are working from home, there may be absolutely no or very little time to give quality instruction to children. Anecdotally, at the start of the pandemic, I was in a surgical residency. My specialty (otolaryngology) was locked down pretty hard across the nation, so I actually was at home a lot during the start of the pandemic, as there was a big scare about risk with routine ENT encounters and surgery. My wife worked in HR and was totally working from home.

For the first two months, I did most of the child care despite being in a busy surgical residency. Our children were about a year old and required a lot of active watching and caring for them. My wife may have been able to step away and change diapers and feed (sometimes she would be tied up). There was certainly no time to give quality education.

To give quality rearing and education to children while working would essentially be the equivalent of working two jobs. Working from home does not necessarily mean you log on, sit at home, and then go about your day as you like (i know some may have been able to do that, for better or worse). I'm not sure why you are insisting that parents taking on this extra burden while working (from home or not) is an unreasonable explanation for this.

Yes, those are the best fo sure

Nosebleeds can happen and certainly do for some. Nasal hydration helps (for instance, ayr gel in combination with saline spray or irrigations). Ultimately, a good portion of patients that don't tolerate or fail nasal steroids get surgery.

Azelaetine is fantastic - there's a lot of patients I prescribe it in conjunction with Flonase. Allergic rhinitis or even just excessive secretions is common in patients with inferior turbinate hypertroph/nasal obstruction, and both meds have a function. They sell it as a combination, actually, but often insurance doesn't cover the combo.

It would by a sympathetic response from catecholamines -- that's how it constricts; however, I didn't know that it had been studied and was actually effective in real life until today.

This applies to nasal decongestants (NOT nasal steroids). Nasal decongestants (such as oxymetazoline AKA afrin, or phenylephrine based medications) are vasoconstrictors. They work very well and work very quickly as the vasoconstriction (constricting the blood vessels) which shrinks the inferior turbinates (and any other edematous tissue).

The body responds to chronic vasoconstriction by making more blood vessels. When the nasal tissues have more blood vessels (and I presume are more dense with vessels) it's harder for the decongestant to work. This is called rebound congestion

conversely, the patients in this scenario will feel they need to use more decongestant since it previously worked so well, but it no longer does. This cycle can be challenging to treat.

For this reason most ENTs, including myself, typically recommend against afrin use for more than 3 consecutive days. I've seen who go as long as five, but I'm cautious and would not recommend more than 3 days.

It's a bit funny, because if you come into my clinic and get an endosocpic exam of the nose and/or throat (i.e. probably around 50%, often more, of my patients on any given day), I will spray afrin and lidocaine into the nose before my examination. The other main thing I use it for is nosebleeds. It's okay to use it for 3 days during an acute exacerbation of sinusitis, but I don't really think it's necessary.

Edit: I forgot to mention nasal steroids. As I said, the above response doesn't apply to them. We don't include nasal steroids in this because they have a very slow effect and don't have the effect of rebound congestion. With few exceptions doing 2 sprays each nostril daily for a very long is fine for almost everybody, and usually helpful. When I prescribe them I recommend patients use them for at least 4 weeks. Once in awhile there are patient that I would be more cautious with prescribing nasal steroids, such as those with a septal perforation, or frequent nose bleeds. Usually it's a non issue. Tip: when spraying them don't spray straight back -- use your opposite hand and spray towards the eye (i.e. spray with right hand into left nostril, aiming towards left eye).

It can happen, but the way most ENTs train these days, unlikely. I've seen it twice that I recall off the top of my head, but very rare these days.

Most ENTs, including myself, are overly cautious. You're at a higher risk for symptom recurrence because of under resection.

That being said, I wouldn't let an oral surgeon or general plastic surgeon touch my family member's nose (unless they had a very very good reputation). Nothing wrong with their work, I'm just not sure they had the same training and respect for the nose.

True; I, and I'm sure most other physicians would not provide identifiable data in a public forum. If you are having issues with nasal obstruction, alternating or otherwise., best advice is to follow up with your pcm for treatment, possible referral.

The best shitposts are the ones that turn out to be real/useful.

Yeah, inferior turbinate reduction is the next small step for this. Often if it's just alternating nasal obstruction that's good enough. Oftentimes there's another component of nasal valve collapse or septal deviation. Personally, in my population, I end up doing septorhinoplasty (nose job) way more often than other smaller nasal surgery.

You don't want them to actually remove the turbinates, however. We generally just shrink them down -- removing them makes the nasal air less turbulent, and difficult to sense airflow. TL;DR it make look like you can drive a semi truck through the nose, but people will feel like they cannot breathe at all. People have killed themselves over this.

Interestingly this may work, but I'm not sure anyone has studied it (perhaps I will do a lit search).

There's erectile tissue in the inferior turbinates that is responsible for the nasal cycle.. maybe after an emission it's more flaccid?

Sadly I do not suffer from inferior turbinate hypertroohy/ alternating nasal obstruction to test this on myself.

Edit: This has been studied.... I now have one more option in the "medical management" toolbox

https://doi.org/10.1177/0145561320981441