Nasal Congestion (The Stuffy Nose) – January 2011

At one time or another during our lives, all of us will suffer from a congested nose. Usually it is temporary, and will respond to simple measures. There are some of us, however, for whom a chronically blocked nose is a way of life. Poor nasal breathing can affect us adversely every hour of the night and day, Fortunately, there are always solutions to this malady, ranging from simple home remedies, to sophisticated, state-of-the-art surgical procedures done easily on an outpatient basis. Hundreds of millions of healthcare dollars are spent on this issue annually. I will try to present a rational approach to the management of this disorder.

Causes of Transient or Seasonal Nasal Blockage

The most common causes of a stuffy nose are minor viral illnesses (viral rhititis—common cold) and nasal allergy. Either condition can be treated by a combination of over-the-counter medication and the use of nasal saline rinses. For cold or flu-related nasal blockage, nantihistamine-decongestant preparations are useful, although they may be excessively drying. Also, decongestants such as pseudoephedrine may raise blood pressure of cause restlessness. Generic forms of non-sedating antihistamines (loratidine and cetirizine) can be used once daily in addition to using nasal saline sprays and rinses for some moderate relief. If nasal blockage is caused by a viral illness (cold), and the above measures fail, over-the-counter medicated sprays suck as Afrin can be used for up to a week, but must be discontinued because they become damaging and “addictive” after several days consecutive use.

Nasal allergy, which may be seasonal (usually spring and fall), or perennial (all year allergies to pets, mold, dust, etc) may be treated with the above mentioned non-sedating antihistamines and saline sprays. The nightly use of a cool mist humidifier also is helpful. Formal allergy testing is available, but is time-consuming and costly. The outcome of allergy testing is all too often the knowledge that one is allergic to certain allergens that are unavoidable, or to a beloved pet that the patient is unwilling to part with. We frequently prescribe steroid nasal sprays (Flonase, Nasonex, Nasacort, Omnaris, Veramyst) to be used from a few weeks, to years on end for some individuals. Similarly, the newer prescription antihistamine sprays (Patanase, Astelin) offer control of nasal allergy without many of the side effects of oral medications and can be used singularly or in conjunction with a steroid spray.

Chronic Nasal Obstruction

While we all suffer from varying degrees of nose congestion at one time of the year or other, there are certain individuals who do not recall the last time they breathed normally through their nose. In fact, these poor souls often accept this as their fate, and spend much of their time mouth-breathing after repeated failures of medical treatment. I will say that it is extremely rare that I cannot find a way to help these individuals, and depending upon the exact cause of their symptom, sometimes change the quality of their life forever.

The most common causes of chronic nasal obstruction are deformities of the nasal bones or septal cartilage, or the growth of polyps or other masses within the nose and sinuses. These issues are easily diagnosed by an ENT specialist, and treatment options can be reviewed after the exam. The so-called “deviated nasal septum” is very common in adults, and children for that matter. It may result from heredity or birth, but more commonly is acquired through a past nasal injury. These injuries can either be significant and memorable, or seem inconsequential at the time of the trauma. Patients with nasal septal deformities usually breathe very poorly from the narrowed side, and intermittently congested on the side opposite the bent cartilage due to turbulent airflow. Nasal turbinates, which are part of our normal nasal anatomy may become progressively enlarged and block breathing as well. The growth of benign nasal polyps can create profound nasal blockage and loss of sense of smell. All of these problems can be corrected as a rule through a relatively simple outpatient operation.

Summary

If nose congestion is more than a periodic annoyance to you, and does not respond to simple over-the-counter or prescription medication, visit us for an evaluation. Unfortunately, the detailed examination of the nose and sinuses is most accurately done by the ENT specialist, although many primary care physicians have become adept at identifying structural blockages in the nose.

Proper nasal breathing is more than a comfort and quality of life issue. Chronic impairment of this function can lead to sinus infections, mouth breathing with acceleration of dental disease, snoring and sleep apnea.

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