Your Stuffy Nose
Nasal congestion, stuffiness, or obstruction to nasal breathing is one of man's oldest and most common complaints. While it may be a mere nuisance to some people, to others it is asource of considerable discomfort, and it detracts from the quality of their lives.
Medical writers have classified the causes of nasal obstruction into four categories, recognizing that overlap exists between these categories and that it is not unusual for a patient tohave more than one factor involved in his particular case.
An average adult suffers a common "cold" two to three times per year; more often in childhood and less often the older he gets as he develops more immunity The common "cold" iscaused by any number of different viruses, some of which are transmitted through the air but mostare transmitted from hand-to-nose contact. Once the virus gets established in the nose, it causesrelease of the body chemical histamine, which dramatically increases the blood flow to the nose -causing swelling and congestion of nasal tissues - and which stimulates the nasal membranes toproduce excessive amounts of mucus. Antihistamines and decongestants help relieve thesymptoms of a "cold," but time alone cures it.
During a virus infection, the nose has poor resistance against bacterial infections, which explains why bacterial infections of the nose and sinuses so often follow a "cold" When the nasalmucus turns from clear to yellow or green, it usually means that a bacterial infection has takenover and a physician should be consulted.
Acute sinus infections produce nasal congestion, thick discharge, and pain and tenderness in the cheeks and upper teeth, between and behind the eyes, or above the eyes and in the forehead,depending on which sinuses are involved.
Chronic sinus infections may or may not cause pain, but nasal obstruction and offensive nasal or postnasal discharge is often present. Some people develop polyps (fleshy growths in thenose) from sinus infections, and the infection can spread down into the lower airways leading tochronic cough, bronchitis, and asthma. Acute sinus infection generally responds to antibiotictreatment; chronic sinusitis usually requires surgery.
Included in this category are deformities of the nose and the nasal septum, which is the thin, flat cartilage and bone that separates the nostrils and nose into its two sides. Thesedeformities are usually due to an injury at some time in one's life. The injury may have been manyyears earlier and may even have been in childhood and long since forgotten. It is a fact that 7percent of newborn babies suffer significant nasal injury just from the birth process; and, ofcourse, it is almost impossible to go through life without getting hit on the nose at least once.
Therefore, deformities of the nose and the deviated septum should be fairly common problems -and they are. If they create obstruction to breathing, they can be corrected with surgery.
One of the most common causes for nasal obstruction in children is enlargement of the adenoids: tonsil-like tissues which fill the back of the nose up behind the palate. Children with thisproblem breath noisily at night and even snore. They also are chronic mouth breathers, and theydevelop a "sad" looking face and sometimes dental deformities. Surgery to remove the adenoidsand sometimes the tonsils may be advisable.
Other causes in this category include nasal tumors and foreign bodies. Children are prone to inserting various objects such as peas, beans, cherry pits, beads, buttons, safety pins, and bits ofplastic toys into their noses. Beware of one-sided foul smelling discharge, which can be caused bya foreign body. A physician should be consulted.
Hay fever; rose fever; grass fever; and "summertime colds" are various names for allergic rhinitis. Allergy is an exaggerated inflammatory response to a foreign substance which, in the caseof a stuffy nose, is usually a pollen, mold, animal dander; or some element in house dust. Foodssometime play a role. Pollens may cause problems in spring (trees), summer (grasses) or fall(weeds), whereas house dust allergies are often most evident in the winter. Molds may causesymptoms year- round. Ideally the best treatment is avoidance of these substances, but that isimpractical in most cases.
In the allergic patient, the release of histamine and similar substances results in congestion and excess production of watery nasal mucus. Antihistamines help relieve the sneezing and runnynose of allergy. Many antihistamines are now available without a prescription. The most familiarbrands include Chlortrimeton, Benadryl, and Dimetane (although most are also available ingeneric forms). Newer; non-sedating antihistamines, which require a prescription, include Seldane,Hismanal and Claritin . Decongestants shrink congested nasal tissues. Examples includeENTex, Guaifed, Deconsal and Sudafed (which is available without a prescription in several generic forms). Combinations of antihistamines with decongestants are also available. All thesepreparations have potential side effects, and patients must heed the warnings of the package orprescription insert. This is especially important if the patient suffers from high blood pressure,glaucoma, irregular heart beats, difficulty in urination, or is pregnant.
Allergy shots are the most specific treatment available, and they are highly successful in allergic patients. Skin tests or at times blood tests are used to make up treatment vials ofsubstances to which the patient is allergic. The physician determines the best concentration forinitiating the treatment. These treatments are given by injection. They work by forming blockingantibodies in the patient's blood stream, which then interfere with the allergic reaction. Injectionsare typically given for a period of three to five years.
Patients with allergies have an increased tendency to develop sinus infections and require treatment as discussed in the previous section.
WARNING: Patients who ge sleepy from antihistamines should not drive an automobile or
operate dangerous equipment after taking them. Also, decongestants stimulate the heart and raise
the pulse and blood pressure; they should be avoided by patients who have high blood pressure,
irregular heart beats, glaucoma or difficulty in urination. Pregnant patients should consult their
obstetrician before taking any medicine. Cortisone-like drugs (corticosteroids) are extremely
potent. These are often administered as nasal sprays for allergy, rather than as pill or by injection,
to minimize the risk of serious side effects associated with these other dosage forms. Patients
using steroid nasal sprays should closely follow their physician’s instructions, and should consult
their physician immediately if they develop nasal bleeding, and crusting, nasal pain or changes invision.
"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, andcapillaries, which have a great capacity for both expansion and constriction. Normally these bloodvessels are in a half- constricted, half-open state. But when a person exercises vigorously, hishormones of stimulation (i.e., adrenalin) increase. The adrenalin causes construction or squeezingof the nasal blood vessels, which shrinks the nasal membranes so that the air passages open upand the person breaths 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 orblocked.
In addition to allergies and infections, other events can also cause nasal blood vessels to expand, leading to vasomotor rhinitis. These include psychological stress, inadequate thyroidfunction, pregnancy certain anti-high blood pressure drugs, overuse or prolonged use ofdecongesting nasal sprays, and irritants such as perfumes and tobacco smoke.
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 conditionpersists for a long enough period, the blood vessels lose their capacity to constrict. They becomesomewhat like varicose veins. They fill up when the patient lies down and when he lies on oneside, the lower side becomes congested. The congestion often interferes with sleep. So it is helpfulfor stuffy patients to sleep with the head of the bed elevated two to four inches -accomplish thisby placing a brick or two under each castor of the bedposts at the head of the bed. Surgery mayoffer dramatic and long time relief.
Stuffy nose is one symptom caused by a remarkable array of different disorders, and the physician with special interest in nasal disorders will offer treatments based on the specific causes.
Additional information and suggestions can be found in the AAO-HNS pamphlets "Hay fever,Summer Colds and Allergies" and "Antihistamines, Decongestants and 'Cold' Remedies." 1995. American Academy of Otolaryngology-Head and Neck Surgery, Inc. This leaflet is published as a public service. The material may be freely used so long as attribution is given to the American Academy of Otolaryngology- Head and Neck Surgery, Inc., Alexandria, VA.


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