Nasal congestion, stuffiness, or obstruction to nasal breathing is one of man’s oldest and most common complaints. While it may be a mere nuisance to some people, to others it is a source of considerable discomfort and it detracts from the quality of their lives.
The causes of nasal obstruction have been classified into four categories:
Infections
An average adult suffers a common "cold” two to three times per year, more often in childhood and less often with age. The common cold is caused by any number of different viruses, some of which are transmitted through the air, but most are transmitted from hand-to-nose contact. Once the virus gets established in the nose, it causes release of the body chemical histamine, which dramatically increases the blood flow to the nose causing swelling and congestion of nasal tissues. This stimulates the nasal membranes to produce excessive amounts of mucus. Antihistamines and decongestants help relieve the symptoms of a cold, but time alone cures it.
During a virus infection, the nose has poor resistance against bacterial infections, which explains why bacterial infections of the nose and sinuses so often follow a cold. When the nasal mucus turns from clear to yellow or green, it usually means that a bacterial infection has taken over and a physician should be consulted.
Acute sinus infections produce nasal congestion, thick discharge and pain and tenderness in the cheeks and upper teeth, between and behind the eyes, or above the eyes and in the forehead, depending on which sinuses are involved.
Chronic sinus infections may or may not cause pain, but nasal obstruction and offensive nasal or postnasal discharge is often present. Some people develop polyps (fleshy growths in the nose) from sinus infections, and the infection can spread down into the lower airways leading to chronic cough, bronchitis and asthma. Acute sinus infection generally responds to antibiotic treatment and chronic sinusitis usually requires surgery.
Structural Causes
Structural causes for congestion include deformities of the nose and the nasal septum, which is the thin, flat cartilage and bone that separates the nostrils and nose into its two sides. These deformities are usually due to an injury at one point in life. It is almost impossible to go through life without getting hit on the nose at least once. These deformities of the nose and the deviated septum are fairly common problems and if they create an obstruction to breathing, they may be corrected with surgery.
One of the most common causes for nasal obstruction in children is enlargement of the adenoids (tonsil-like tissues which fill the back of the nose up behind the palate). Children with this problem breathe noisily at night and even snore. They also are chronic mouth breathers, and they develop a "sad” looking face and sometimes dental deformities. Surgery to remove the adenoids and sometimes the tonsils may be advised.
Other causes of deformities include nasal tumors and foreign bodies. Children are prone to inserting various objects such as peas, beans, cherry pits, beads, buttons, safety pins, and bits of plastic toys into their noses. This can lead to one-sided foul smelling discharge and if detected a physician should be consulted.
Allergy
Allergies are an exaggerated inflammatory response to a foreign substance which, in the case of a stuffy nose, is usually pollen, mold, animal dander or some element in house dust. Foods sometime play a role. Pollens may cause problems in spring (trees), summer (grasses) or fall (weeds), whereas house dust allergies are often most evident in the winter. Molds may cause symptoms year- round. Ideally the best treatment is avoidance of these substances, but that is impractical in most cases.
In the allergic patient, the release of histamine and similar substances results in congestion and excess production of watery nasal mucus. Antihistamines help relieve the sneezing and runny nose associated with allergies and common antihistamines are now available without a prescription. The most familiar brands include Chlortrimeton®, Benadryl®, and Dimetane®. Newer, non-sedating antihistamines, which require a prescription, include Seldane®, Hismanal®, and Claritin®. Decongestants shrink congested nasal tissues. Examples include ENTex®, Guaifed®, Deconsal®, and Sudafed® (which is available without a prescription in several generic forms). Combinations of antihistamines with decongestants are also available. All these preparations have potential side effects, and patients must heed the warnings of the package or prescription insert. This is especially important if the patient suffers from high blood pressure, glaucoma, irregular heart beats, difficulty in urination, or is pregnant.
Allergy shots are the most specific treatment available, and they are highly successful in allergic patients. Skin tests or, at times blood tests, are used to compose treatment vials of substances to which the patient is allergic. The physician determines the best concentration for initiating the treatment. These treatments are given by injection. They work by forming blocking antibodies in the patient’s blood stream, which then interfere with the allergic reaction. Injections are typically given for a period of three to five years.
Patients with allergies have an increased tendency to develop sinus infections and require treatment as discussed in the previous section.
Vasomotor Rhinitis
Rhinitis means inflammation of the nose and nasal membranes. Vasomotor means blood vessel forces. The membranes of the nose have an abundant supply of arteries, veins, and capillaries, which have a great capacity for both expansion and constriction. Normally these blood vessels are in a half- constricted, half-open state. But when a person exercises vigorously, adrenalin increases. The adrenalin causes squeezing of the nasal blood vessels, which shrinks the nasal membranes so that the air passages open up and the person breathes more freely.
The opposite takes place when an allergic attack or a cold develops. The blood vessels expand, the membranes become congested (full of excess blood) and the nose becomes stuffy or blocked. In addition to allergies and infections, other events can also cause nasal blood vessels to expand, leading to vasomotor rhinitis. These include psychological stress, inadequate thyroid function, pregnancy, certain anti-high blood pressure drugs, overuse or prolonged use of decongesting nasal sprays and irritants such as perfumes and tobacco smoke.
In the early stages of each of these disorders, the nasal stuffiness is temporary and reversible. That is, it will improve if the primary cause is corrected. However, if the condition persists for a long enough period, the blood vessels lose their capacity to constrict. They fill up when the patient lies down and when he lies on one side, the lower side becomes congested. The congestion often interferes with sleep. It is helpful for stuffy patients to sleep with the head of the bed elevated two to four inches. Surgery may offer dramatic and long time relief.
