Nasal congestion is a very common problem. It can affect quality of life.
Nasal Congestion / Chronic Rhinitis Causes:
- Bacterial (Acute and Chronic Rhinosinusitis)
- Allergic Rhinitis
- Vasomotor Rhinitis
- Rhinitis of Pregnancy
“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, the hormones of stimulation (i.e., adrenaline) increase. The adrenaline causes constriction or squeezing of 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.
Chronic Vasomotor Rhinitis Symptoms:
- Nasal obstruction
- Runny nose, postnasal drainage
- Sneezing not triggered by allergy
Chronic Vasomotor Rhinitis Triggers:
- Irritants such as chemicals, perfumes, poor air quality and tobacco smoke
- Change in temperature, change in weather
- Lying flat
- Psychological stress
- Certain high blood pressure drugs
- Overuse or prolonged use of decongesting nasal sprays (Afrin, Neo-Synephrine)
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 long enough, the blood vessels lose their capacity to constrict. They become somewhat like varicose veins. They fill up when the patient lies down and when he/she 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 accomplish this by placing a brick or two under each castor of the bedposts at the head of the bed. Surgery may offer dramatic and long term relief.
Chronic Rhinitis Evaluation and Treatment:
- Complete history and physical examination to obtain accurate diagnosis
- Diagnostic testing if indicated:
- In office nasal endoscopy
- Allergy skin testing
- Sinus CT Scan
*** Treatment Options Include:
- Environmental changes to minimize allergen / irritant exposure
- Saline nasal irrigation
- Nasal sprays
- Surgical intervention if indicated
- Nasal septoplasty (straighten deviated septum)
- Inferior turbinate reduction
- Endoscopic sinus surgery
Sarin, S., B. Undem, et al. (2006). “The role of the nervous system in rhinitis.” J Allergy Clin Immunol 118(5): 999-1016.
Pynnonen, M. A., S. S. Mukerji, et al. (2007). “Nasal saline for chronic sinonasal symptoms: a randomized controlled trial.” Arch Otolaryngol Head Neck Surg 133(11): 1115-20.
American Academy of Otolaryngology−Head and Neck Surgery. One Prince St., Alexandria, VA 22314-3357, 1-703-836-4444. 2010 AAO-HNS/AAO-HNSF