Nasal Congestion
Nasal congestion, a feeling of fullness, or difficulty breathing through the nose, is one of humanity's oldest complaints. While for some, this may be an insignificant condition, for others, it can be very distressing.
In medical sources, four main reasons causing nasal congestion have been identified: infection, structural abnormalities, allergic rhinitis, and non-allergic (vasomotor) rhinitis. Although these reasons vary from person to person, they often occur in conjunction.
Causes of Nasal Congestion
Infection
An average, healthy adult may experience 2-3 episodes of viral infections per year. As immunity strengthens with age, these viral infections are more common in childhood. Many of these viruses are airborne and often transmitted to the nose by hand contact. When the virus is inhaled through the nose, the body releases a substance called histamine. Histamine causes increased blood flow in the nasal tissues, resulting in swelling of the nasal mucosa and excessive mucus secretion. These effects are the cause of nasal congestion. The use of decongestant and antihistamine medications can help reduce these effects, but they are not curative. However, the condition usually resolves spontaneously over time.
During a viral infection, the nose's resistance to bacteria decreases, leading to bacterial infections in the nose and sinuses, typically following viral infections. A change in the color of nasal mucus to yellow or green indicates the development of a bacterial infection. In such cases, consulting an Ear, Nose, and Throat (ENT) specialist is advisable.
Acute sinus infections can cause fullness in the nose and intense nasal discharge. Pain can occur around the cheeks, upper teeth, cheekbones, forehead, between the eyes, above the eyes, and behind the eyes, depending on the sinuses affected by the infection.
Chronic sinus infections can be painful or painless, but nasal congestion and postnasal drip are usually prominent. Some individuals may develop formations inside the nose called polyps. These can affect the lower respiratory tract, leading to chronic cough, bronchitis, or setting the stage for asthma. While acute sinus infections typically respond well to antibiotics, chronic sinusitis may require surgical intervention.
Structural Abnormalities
Structural issues that cause nasal congestion typically arise from deviations in the bone-cartilage structure called the septum, which separates the two nasal cavities. A history of underlying trauma is often present. Such traumas can occur in adulthood, childhood, or even during birth. Correcting the underlying cause of the obstruction can often be achieved through surgical methods.
In children, one of the most common causes of nasal congestion is adenoid hypertrophy (enlargement of the adenoids). The adenoid tissue, similar to tonsil tissue, is located at the back of the upper palate behind the nose. Enlargement of the adenoids can obstruct the airway, leading to mouth breathing, noisy breathing, and/or snoring during sleep. Prolonged mouth breathing in children can result in the development of a long face and abnormalities in tooth development and placement. The solution in such cases is the surgical removal of the adenoids and/or tonsils.
Tumors or foreign bodies in the nose can also be causes of structural nasal congestion. Foreign bodies are more commonly observed during childhood, especially in the context of play. Typically, unilateral malodorous nasal discharge accompanies the presence of foreign bodies.
Allergies
Nasal allergies are generally caused by an excessive inflammatory response to substances such as pollens, molds, animal dander, or dust mites. Pollens are usually effective in the spring-summer and fall seasons, while allergies to molds and dust mites can occur year-round. Allergic individuals produce excessive and watery nasal discharge, nasal congestion, and a feeling of fullness in the nose due to the secretion of histamine and similar substances. Antihistamine medications help relieve frequent sneezing and nasal discharge caused by allergies.
More precise and successful treatment for allergic conditions is allergy-specific treatments. These treatments are administered through vaccines or drops prepared with the substance causing the allergy, as determined by allergy tests.
Vasomotor Rhinitis
Rhinitis refers to inflammation of the nasal membranes. The term vasomotor is used to indicate nerves that control blood vessels. The nasal mucosa contains a dense network of arteries, veins, and capillaries. These vessels have the ability to contract and relax. Under normal circumstances, the vessels are partially contracted and partially relaxed. For example, in exercise situations, the hormone adrenaline increases the contraction of these vessels, opening the airway. On the other hand, allergic conditions or the flu situation relaxes the vessels, increasing nasal congestion and discharge.
Psychological stress, inadequate thyroid hormone, pregnancy, certain blood pressure medications, long-term use of decongestant nasal sprays, and exposure to chemicals such as perfumes and smoke can also cause the nasal vessels' walls to relax, leading to nasal congestion.
In the early stages of such conditions, the feeling of fullness in the nose is generally temporary and recovers spontaneously. Eliminating the factor causing the problem is usually sufficient. However, if the factor persists, the contractile capacity of the vessel walls decreases over time, and the congestion becomes permanent. In such cases, surgical methods provide a permanent and effective solution.
Is there a risk in the treatment of nasal congestion?
- Antihistamines should be avoided in situations where attentiveness is required due to their tendency to cause drowsiness.
- Decongestant medications should not be used in individuals with high blood pressure, heart problems, glaucoma, or difficulty urinating.
- Pregnant patients should consult a specialist before using medication.
- Corticosteroid-containing medications are generally safe, especially when used in spray form, and have minimal side effects. However, prolonged use may lead to dryness in the nasal passages and subsequent nosebleeds. If such issues arise, consulting an ENT specialist is recommended.
The Nasal Septum and Turbinates
The nasal septum is the structure made up of bone and cartilage that separates the right and left nasal cavities.
