Nasal congestion

Nasal congestion
Specialty	Otorhinolaryngology

Nasal congestion is the blockage of the nasal passages usually due to membranes lining the nose becoming swollen from inflamed blood vessels. It is also known as nasal blockage, nasal obstruction, blocked nose, stuffy nose,plugged nose.

Nasal congestion has many causes and can range from a mild annoyance to a life-threatening condition. The newborn infant prefers to breathe through the nose (historically referred to as "obligate nasal breathers"). Nasal congestion in an infant in the first few months of life can interfere with breastfeeding and cause life-threatening respiratory distress. Nasal congestion in older children and adolescents is often just an annoyance but can cause other difficulties.

Nasal congestion can interfere with the ears, hearing, and speech development. Significant congestion may interfere with sleep, cause snoring, and can be associated with sleep apnea. In children, nasal congestion from enlarged adenoids has caused chronic sleep apnea with insufficient oxygen levels and hypoxia, as well as right-sided heart failure. The problem usually resolves after surgery to remove the adenoids and tonsils.

Nasal congestion can also cause mild facial and head pain, and a degree of discomfort.

Causes

• Allergic reaction
• Common cold or influenza
• Deviated septum
• Hay fever, allergic reaction to pollen or grass
• Reaction to medication (e.g. Flomax)
• Rhinitis medicamentosa a condition of rebound nasal congestion brought on by extended use of topical decongestants (e.g., oxymetazoline, phenylephrine, xylometazoline, and naphazoline nasal sprays).
• Sinusitis or sinus infection
• If the body is in a position where a lot of blood enters the head (e.g. upside down), the blood vessels in the nasal passage may inflame.
• Many women suffer from nasal congestion during pregnancy due to the increased amount of blood flowing through the body.
• Nasal polyps
• Concha bullosa
• Empty nose syndrome

Gastric reflux

Studies have shown a significant correlation between individuals suffering from chronic sinusitis and those suffering from acid reflux. In some cases, severe acid reflux can reach the nasal or nasopharyngeal area, causing irritation. Gastroesophageal reflux disease therapy has proven effective in the treatment of chronic sinusitis. Proton pump inhibitor type medications were shown to improve at least some sinusitis symptoms for most people, and dramatically so in some.

Assessment of nasal obstruction

Nasal obstruction characterized by insufficient airflow through the nose can be a subjective sensation or the result of objective pathology. It is difficult to quantify by subjective complaints or clinical examinations alone, hence both clinicians and researchers depend both on concurrent subjective assessment and on objective measurement of the nasal airway. Often a doctor's assessment of a perfectly patent nasal airway might differ with a patient's complaint of an obstructed nose.

Treatment

The treatment of nasal congestion frequently depends on the underlying cause.

Alpha-adrenergic agonists are the first treatment of choice. They relieve congestion by constricting the blood vessels in the nasal cavity, thus resulting in relieved symptoms. Examples include oxymetazoline and phenylephrine.

Both influenza and the common cold are self limiting conditions that improve with time; however, drugs such as acetaminophen (paracetamol), aspirin, and ibuprofen may help with the discomfort.

A cause of nasal congestion may also be due to an allergic reaction caused by hay fever, so avoiding allergens is a common remedy if this becomes a confirmed diagnosis. Antihistamines and decongestants can provide significant symptom relief although they do not cure hay fever. Antihistamines may be given continuously during pollen season for optimum control of symptoms. Topical decongestants should only be used by patients for a maximum of 3 days in a row, because rebound congestion may occur in the form of rhinitis medicamentosa.

Nasal decongestants target the discomfort directly. These come as nasal sprays like naphazoline (Privine), oxymetazoline (Afrin, Dristan, Duramist), or phenylephrine (Neo-Synephrine, Sinex, Rhinall) or as oral pills (Bronkaid, Sudafed, Neo-Synephrine, Sinex, Rhinall). Oral decongestants may be used for up to a week without consulting a doctor, with the exception of Bronkaid and Sudafed, which can be taken as long as needed, but nasal sprays could worsen the congestion if taken for many days; therefore, you should only take nasal sprays when discomfort cannot be remedied by other methods, and never for more than three days.

If an infant is unable to breathe because of a plugged nose, a nasal aspirator may be useful to remove the mucus. The mucus might be thick and sticky, making it difficult to expel from the nostril.

If you suffer from nasal congestion for more than seven days, see your doctor.

The use of nasal irrigation may help reduce nasal congestion. It involves rinsing the nasal cavity with saline to clear out allergy-causing microscopic particles of dust and pollen that cling to the inner nasal membranes.