Nasal congestion is a difficulty in nasal breathing. The symptom is often accompanied by nasal discharge, headaches, sleep disorders. Unpleasant manifestations can be caused by both physiological causes and various diseases of the nasal cavity, allergic reactions, pathologies of anatomical structures. To identify the cause of congestion, rhinoscopy, radiography of the paranasal sinuses, laboratory tests and allergy tests are performed. As a symptomatic treatment, non-drug methods, nasal drops are used before diagnosis.
General characteristics
Regardless of the cause, nasal congestion often develops gradually: a person notices difficulties with nasal breathing, a subjective feeling of lack of air appears. The condition is accompanied by discomfort in the forehead and bridge of the nose, dryness of the nasal epithelium. With pronounced difficulty in passing the air flow, patients breathe through an open mouth, their sense of smell decreases. There is often a combination of stuffiness with sleep disorders — in a horizontal position, symptoms increase, so people have to sleep half-sitting, leaning on high pillows.
A few hours after the onset of nasal breathing disorders, other symptoms often join – mucous discharge, itching, sneezing. Sometimes breathing is disturbed only on one side, and when lying on your side, a feeling of stuffiness of the nostril located below is typical. With a chronically stuffy nose, not enough oxygen enters the body, which is manifested by persistent headaches. If difficult nasal breathing persists for 3-4 days, disorders of the general condition increase, insomnia worries, it is necessary to consult a specialist.
Causes of nasal congestion
Physiological
The nasal epithelium is in contact with all external stimuli that are in the atmospheric air. The impact of adverse factors causes swelling of the mucous membrane, which in healthy people is of a short-term nature. The appearance of congestion is more often caused by low humidity in the room: in apartments, especially in winter when central heating is running, the moisture content does not exceed 40% (the normal level is 50-60%). There are other causes of nasal breathing difficulties: exposure to cold air, tobacco smoke, pungent odors.
Allergy
Allergic diseases occupy the first place among the causes of nasal congestion (18-38% of all cases). The symptom may occur when inhaling dust, pungent odors, and flower scents. Violations develop within a few minutes. Congestion is preceded by a feeling of discomfort and itching, lacrimation. Upon contact with the allergen, the mucous membrane of the nasal passages swells, and in severe cases completely closes. Breathing through the nose, as a rule, recovers independently after eliminating the cause (cessation of contact with the trigger factor).
Allergic rhinitis is characterized by an increase in symptoms in spring and early summer — during the flowering period of trees and shrubs. Patients complain of pronounced breathing difficulties, which worsen when leaving the room. With a combination of congestion with abundant serous discharge, lacrimation and redness of the eyes, they talk about pollinosis. Such manifestations significantly worsen the quality of life, the symptoms are poorly relieved by vasoconstrictive nasal drops.
ARVI
Difficulty inhaling through the nose is one of the first signs of viral rhinitis, moderate congestion persists throughout the entire period of treatment. Typical complaints of pronounced dryness of the nasal mucosa, causing discomfort. The sense of smell decreases sharply, and its recovery is delayed up to a week or more. Swelling of the epithelium in viral infections is accompanied by weakness, severe headaches, and an increase in body temperature. Most often, such symptoms are caused by rhinovirus infection, influenza.
Chronic rhinitis
Nasal breathing difficulties that last more than 1 month are characteristic of chronic inflammatory processes in the nasal cavity. There is a constant presence of pathological symptoms, the connection between exacerbations and the effects of external factors is often not traced. Nasal congestion is most severe in hypertrophic rhinitis: significant overgrowth of the nasal conchae creates a mechanical obstacle to the passage of air. In pregnant women, the disorder is usually associated with vasomotor rhinitis.
Inflammatory processes of ENT organs
Any inflammation in the upper respiratory tract is accompanied by reactive swelling of the nasal mucosa, which makes it difficult to inhale air through the nose. Symptoms worsen in the evening and at night. The symptom occurs against the background of pain in the frontal region, the bridge of the nose, sore throat, coughing, and an increase in body temperature. Congestion is caused by the following reasons:
- Sinusitis: frontitis, sinusitis, ethmoiditis.
- Diseases of the upper respiratory tract: pharyngitis, laryngitis.
- Chronic tonsillitis.
Nasal polyps
The appearance of nasal congestion is characteristic of the early stages of overgrowth, when there are no other symptoms. Patients feel discomfort in the bridge of the nose, nasal breathing disorders are most pronounced in the morning, immediately after waking up. For polyps, difficulty in exhaling is typical — patients inhale freely enough, and on exhalation, the polypous tissue plays the role of a flap. With the disease, mucociliary clearance and mucus outflow change, so the discharge from the nasal cavity flows down the back wall of the pharynx, causing sore throat and discomfort.
Adenoids
Increased adenoid vegetations in children create significant obstacles to the passage of air masses through the nose through the respiratory tract. Congestion is pronounced strongly, especially at night. The child breathes through his mouth, which causes a characteristic appearance – a constantly open mouth, smoothed nasolabial folds, dry lips with cracks. Due to the impossibility of normal inhalation of air, sleep is disturbed, loud snoring is noted. The disease is combined with frequent and prolonged rhinitis, which further aggravate respiratory disorders.
Damage to the nasal septum
Violation of the anatomical structures of the nasal cavity is more often manifested by unilateral congestion. Complaints are made about difficulty or complete inability to inhale air through one nostril, while the symptom is constant and does not change in the side position. Vasoconstrictive drops used for treatment have no effect. With severe curvature, the shape of the nose changes noticeably. The most common causes of impaired nasal breathing due to deformity of the bone part: congenital defects of the septum or trauma to the bones of the facial skull.
Complications of pharmacotherapy
The occurrence of drug-induced rhinitis is most often associated with prolonged uncontrolled use for the treatment of topical decongestants (vasoconstrictive nasal drops with adrenomimetics). The use of these drugs for 7-10 days causes “ricochet” obstruction — severe swelling of the mucous layer, which does not decrease with further instillation of adrenomimetics. Among other medications, tamsulosin has the greatest effect on nasal breathing — a remedy for the treatment of prostatic hyperplasia in men.
Rare causes
- Autoimmune diseases: Wegener’s granulomatosis, Sjogren’s syndrome, systemic scleroderma.
- Empty nose syndrome: as a complication after a conchotomy.
- Congenital pathologies: Cartagenera syndrome, cystic fibrosis.
- Hormonal changes: puberty, in women before menopause.
- Malignant tumors of the nose.
Diagnostics
An otolaryngologist examines the patient and determines the cause of nasal congestion. Diagnostic search involves instrumental examination of the nasal cavity and the nearby respiratory tract. In order to clarify the diagnosis, laboratory tests are prescribed. The most valuable and informative are:
- Rhinoscopy. During an instrumental examination of the nasal mucosa, inflammatory processes, deformations, and bulky formations that could cause breathing difficulties are detected. To differentiate hypertrophic and vasomotor rhinitis, an adrenaline test is performed.
- X-ray examination. When complaining of a stuffy nose, radiography of the paranasal sinuses (maxillary, frontal) is performed in order to detect exudate and other signs of sinusitis. To clarify the nature of the inflammatory process, puncturing of the sinus is possible.
- Laboratory tests. To exclude infection with the help of bacteriological seeding, nasal discharge is examined for the presence of pathogenic microorganisms. If the viral etiology of the disorder is suspected, an express method is prescribed – the determination of virus particles in nasal epithelial. The viral or bacterial etiology of the disease is also confirmed during serological reactions (IFA, PCR).
Instrumental methods of examination — pharyngoscopy and laryngoscopy – are shown to quickly determine the cause of nasal breathing difficulties. In order to confirm the allergic nature of nasal congestion in the period of exacerbation of symptoms, an extended immunogram is performed, after the clinical manifestations subside, allergy tests with the most common antigens are recommended. In difficult cases, other specialists are involved for examination.
Treatment
Help before diagnosis
Unpleasant symptoms can be reduced with the help of non-drug treatment. It is recommended to increase the humidity in the room. To do this, it is better to purchase a special humidifier. The patient needs to avoid strong odors, a sharp change of cold and warm air. You need to sleep on a high pillow so that the head is in an elevated position all the time — this reduces the swelling of the mucous membrane. Persistent breathing disorders through the nose are more often a sign of illness, therefore, to determine the cause of the disorder, it is necessary to seek qualified medical help.
Drug therapy
The choice of treatment tactics depends on the cause of the disease. Symptomatic therapy in the form of nasal drops with adrenomimetics is recommended for short-term use during the period of the greatest severity of unpleasant sensations, but it does not affect the causes of congestion. The basis of the treatment regimen in patients with impaired nasal breathing is usually medication methods. As etiotropic and pathogenetic therapy is used:
- Topical corticosteroids. Inhaled forms of hormones are considered the most effective for the treatment of allergic rhinitis, vasomotor rhinitis. They also significantly slow down the growth of nasal polyps. Modern medicines are not absorbed into the bloodstream and do not have side effects.
- Antiallergic drugs. Antihistamines, stabilizers of mast cell membranes are used to eliminate swelling and congestion, prevent exacerbations of pollinosis. With prolonged use, these medications serve as the basic therapy for allergic conditions.
- Antibiotics. For the treatment of rhinitis and sinusitis, various antibacterial agents are prescribed – penicillins, macrolides, cephalosporins. Initially, the selection of drugs is carried out empirically. After receiving the results of bacteriological seeding, the therapy regimen is adjusted.
Physical therapy
Rinsing the nasal cavity with saline solutions helps to eliminate dryness of the mucous membrane. In patients with chronic diseases of the nasal cavity, along with medications, physiotherapy methods are actively used — galvanotherapy, darsonvalization, microwave therapy, which stimulate blood circulation, improve the processes of immune protection. To enhance the effect of medications, they are injected directly into the affected area using electrophoresis.
Surgical treatment
To eliminate nasal congestion caused by the curvature of the septum, surgical intervention — septoplasty is indicated. Surgical methods are also used to treat polyposis: endoscopic removal of the volume formation is most often performed, after which nasal breathing is restored. Surgical correction is subject to advanced variants of hypertrophic rhinitis: during the intervention, a specialist performs a conchotomy, removing part of the nasal conch to eliminate a mechanical obstacle to the passage of air.