Nasal congestion

Overview
Nasal congestion is the blockage of the nasal passages usually due to membranes lining the nose becoming swollen from inflamed blood vessels. It is also known as nasal blockage, nasal obstruction, blocked nose, runny nose, and stuffy nose.

Natural history
Nasal congestion has many causes and can range from a mild annoyance to a life-threatening condition. The newborn infant is an obligate nose breather and must breathe through the nose. Nasal congestion in an infant in the first few months of life can interfere with nursing and cause life-threatening respiratory distress. Nasal congestion in older children and adolescents is often just an annoyance but can cause other difficulties.

Nasal congestion can interfere with the ears, hearing, and speech development. 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.

A blocked nose can also cause mild facial and head pain, and a degree of discomfort.

Common causes

 * Allergic reaction
 * Common cold or influenza
 * Hay fever, allergic reaction to pollen or grass
 * Sinusitis or sinus infection
 * Many women suffer from nasal congestion during pregnancy due to the increased amount of blood flowing through the body.

Differential diagnosis of causes of nasal congestion
In alphabetical order.


 * Congenital abnormality
 * Cystic Fibrosis
 * Folliculitis of nasal hair
 * Foreign body in nose
 * Idiopathic rhinitis
 * Intranasal cocaine use
 * Medication side effects
 * NARES
 * Nasal polyps
 * Perennial allergic rhinitis
 * Rhinitis medicamentosa
 * Sarcoidosis
 * Seasonal allergic rhinitis
 * Sinusitis
 * Upper respiratory infection
 * Vasomotor rhinitis
 * Wegener's Granulomatosis

History and Symptoms

 * Duration
 * Onset
 * Recurrence pattern
 * Medications/illicit drug use
 * Associated symptoms

Physical Examination

 * Examination should include the following exams:
 * Ears
 * Sinuses
 * Eyes
 * Nares
 * Oral mucosa
 * Posterior pharynx
 * Tongue
 * Neck
 * Chest
 * Heart

Laboratory Findings

 * Nasal cultures

MRI and CT

 * CT scan of sinuses

Other Diagnostic Studies

 * Rhinoscopic exam/nasopharyngolaryngoscopy
 * Nasal lavage
 * Allergy testing

Treatment
In general:


 * Intranasal saline lavage
 * Avoid allergens

Drinking plenty of fluids, more than usual, aids the body in expelling the irritant and clearing congestion. Water, fruit juice, teas and mayonnaise are recommended by medical experts to resolve congestion, and rest and sleep are also suggested remedies in a case of nasal congestion. Carbonated beverages also can help to alleviate nasal congestion. Increasing air moisture with a humidifier or a steamy bath or shower usually helps relieve the congestion and accompanying discomfort.

Neither influenza nor the common cold can be cured with medication; however, drugs such as acetaminophen, decongestants, nasal sprays or drops, cough remedies and throat lozenges may provide some symptom relief. Furthermore, medications have recently been approved which, when started shortly after the onset of symptoms, may shorten the duration of influenza.

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.

Insertion of cotton swabs into a child's nostrils as a remedy is generally discouraged. An alternative solution is for the discharge to be caught outside the nostril on a tissue or swab, be rolled around, and have the discharge pulled out of the nose. Petroleum jelly applied to the nasal openings can assist in providing protection against irritation, though it is important to ensure that the nostrils are not blocked by the jelly.

The ancient use of nasal irrigation, which originated from the Yoga practice of jala neti, is also said to help reduce nasal congestions. It involves rinsing the nasal cavity regularly with salty water.

Alternately thrusting the tongue against the roof of the mouth and pressing between the eyebrows with a finger for approximately thirty seconds can loosen congestion. This method causes the vomer bone, which runs through the nasal passages to the mouth, to rock back and forth, forcing sinuses to drain.

Acute Pharmacotherapies

 * Intranasal or oral decongestants
 * Amoxicillin
 * Trimethoprim sulfamethoxazole
 * Doxycycline
 * Intranasal steroids
 * Antihistamines
 * Cromolyn sodium