Nasal congestion
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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.
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. [1] [2]
- 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.[3]
Acute Pharmacotherapies
- Intranasal or oral decongestants
- Amoxicillin
- Trimethoprim sulfamethoxazole
- Doxycycline
- Intranasal steroids
- Antihistamines
- Cromolyn sodium
References
- ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
- ↑ http://health.msn.com/menshealth/articlepage.aspx?cp-documentid=100119940>1=7538