Nasal Congestion

At San Diego Ear, Nose & Throat Specialists, nasal congestion is one of the most common complaints patients are evaluated for.  Nasal congestion is a very common complaint which affects most people at some time in their life. In many cases, nasal congestion is usually only temporary and caused by a virus or allergies. These cause blood vessels in the nose to become inflamed and the nasal mucosa to become inflamed and swell. The common cold (rhinovirus) is the most common viral infection causing nasal congestion.

If you have chronic, constant nasal congestion there may be another reason behind why this is happening to you. There are several different causes of nasal congestion.

Deviated Nasal Septum

The nasal septum is the wall that divides the left and right nostrils. This is made of both bone and cartilage and should divide the nasal cavity in half. It is estimated that about 80% of people, unknowingly, have some misalignment of their nasal septum. If the septum is significantly off-centered, this will make breathing through your nose much more difficult. Symptoms include difficulty breathing through the nose (especially one nostril).

Turbinate Hypertrophy

The nasal cavity contains bony structures called turbinates. They help filter, warm, and humidify the air as you breathe. Because the turbinates are situated directly in the nasal passages, these are susceptible to irritation from dust and allergies, which can cause swelling and decrease the airflow through the nasal passages.

Nasal Polyps

A nasal polyp is a soft, painless, benign (noncancerous) growth that grows from the lining of the nose or sinuses. They usually hang down like teardrops or grapes in the nasal cavity. Polyps usually occur in both the right and left nasal passages. Small nasal polyps may not cause symptoms but larger polyps or groups of polyps can cause nasal congestion. They can make your nose feel stuffy, lead to frequent sinus infections, and can decrease your sense of smell.

Enlarged Adenoids

Enlarged adenoids are common in children. The adenoids are soft tissue that sits behind the nose above the roof of the mouth. They create antibodies that aid the immune system to fight infection.  When they grow large, they can cause snoring and breathing problems.  The adenoids can become enlarged due to an infection or maybe enlarged from birth.

Swelling of The Nasal Lining Due to Allergies

An allergy is a hypersensitivity disorder of the immune system. Allergies are the result of the immune system’s response to a harmless substance. Common triggers of allergic rhinitis include pollen, dust, and pet dander. When an allergen is encountered, antibodies are produced, which in turn triggers the release of chemicals called histamines. The release of histamine is responsible for a stuffy nose caused by swelling of the nasal lining and symptoms may include sneezing, runny nose, and itchy eyes. It’s not clear why some people develop allergic rhinitis, but having a family history of allergies is a risk factor.

Pregnancy Rhinitis

Pregnancy affects many parts of the body, and that can include the nose. During pregnancy, hormones including progesterone and estrogen increase. The rise in hormones along with increased blood flow can cause swelling of the mucous membranes inside the nose. Symptoms may include stuffy nose and sneezing. Pregnancy rhinitis can occur at any time during pregnancy. Symptoms usually go away shortly after delivery.

When you begin your consultation with your ENT physician, they will begin with a thorough review of your medical history. It is of great importance for your physician to understand what your nasal congestion symptoms are, their duration, association with seasons or other environmental exposures (allergies, smoking, etc), as well as the full range of treatments that you have tried, for how long you have tried them, and their efficacy. A thorough physical exam will be performed including a nasal endoscope (a small lighted/optical instrument) that will be used to look inside the nose. This provides your physician with an enhanced view of your entire nasal cavity.

Additional testing may be performed to determine the cause of your nasal congestion. Some common tests are CT scans, nasal cultures, and allergy testing. CT scans are able to give a detailed look into the sinuses and nasal cavity and are useful in establishing a diagnosis and if indicated, surgical planning. Allergy testing is done to both confirm the cause of nasal congestion and to identify specific allergens. Nasal cultures are done to determine if there is an infection and antibiotic is needed. Your ENT physician will determine which combination of testing is suitable for your specific case.

Many causes of nasal congestion are self-limited but some will require treatment from a physician. This often includes oral antibiotics, nasal steroid sprays, oral steroids, nasal antihistamine sprays, oral antihistamines. An effective long-term solution may require surgery particularly if the issue involves a deviated septum, turbinates, or nasal polyps. Newer surgical techniques include shrinking the turbinates by using radiofrequency energy or a small tissue-shaving device.