Nasal congestion

This article concerns nasal congestion as a symptom. For the natural partial congestion of the nose, see nasal cycle.

Medical products for diminution of nasal congestion

Nasal congestion is the blockage of the nasal passages usually due to membranes lining the nose becoming swollen from inflamed blood vessels.^[1] It is also known as nasal blockage, nasal obstruction, blocked nose, stuffy nose, or plugged nose.

Nasal decongestants target the discomfort directly. These come as nasal sprays, inhalers, and as oral pills.

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").^[2] Nasal congestion in an infant in the first few months of life can interfere with breastfeeding and cause life-threatening respiratory distress; in older children and adolescents it is often just an annoyance but can cause other difficulties.

Nasal congestion can interfere with the hearing and speech. 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, however the problem often relapses later in life due to craniofacial alterations from chronic nasal congestion.^[3]

Nasal congestion can also cause mild facial and head pain, and a degree of discomfort, often from allergies or the common cold.

Causes

• Allergies,^[4] like hay fever,^[4] allergic reaction to pollen or grass
• Common cold^[4] or influenza
• Deviated septum
• Reaction to medication (e.g. Flomax)
• Rhinitis medicamentosa^[4] 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^[4]
• Inversion may cause blood vessels in the nasal passage to inflame.
• Narrow or collapsing nasal valve.^[5]
• Pregnancy may cause women to suffer from nasal congestion due to the increased amount of blood flowing through the body.^[4]
• Nasal polyps^[4]
• Concha bullosa
• Empty nose syndrome
• Gastroesophageal reflux disease (theorized to cause chronic rhinosinusitis- the "airway reflux paradigm")^[6]

Nasal obstruction

Nasal obstruction characterized by insufficient airflow through the nose can be a subjective sensation or the result of objective pathology.^[7] 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.^[8] 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), as inhalers, 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 can also cause "rebound" (Rhinitis medicamentosa) and worsen the congestion if taken for more than a few days. Therefore, you should only take nasal sprays when discomfort cannot be remedied by other methods, and never for more than three days.^[9]

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.

See also

• Decongestant
• Inhaler

References