Nasal congestion, also known as stuffy nose or stuffed up nose, nasal blockage, blocked nose, or nasal obstruction is a condition that exists when the nasal passages’ membranes, ranging from the exterior nares or nostrils to the interior nares also called choana, become swollen and irritated from inflamed blood vessels in mucosal membranes. Although they may occur separately, nasal congestion and rhinnorrhea or runny nose, often occur together.
Nasal congestion is usually accompanied by excess mucous occurring in the nasal passages as well. However, this may be true occasionally, but it is not the most common reason why the nose gets congested. The most common cause for a stuffy nose is that the tissue lining it (mucous membrane) becomes swollen, usually due to some sort of irritation.
For most non-infant children and adults, this is commonly more of an annoyance than a serious condition. However, for newborn infants, breathing through the nose is crucial and nasal congestion in the first months after birth could interfere with nursing and possibly cause serious breathing difficulty.
Type of Condition
Nasal congestion is an abnormal physiological condition that should not be confused with the human nasal cycle. During a twenty four hour period, the human nostrils will take turns being engorged with blood and swelling, and then shrinking so that only one nostril is working at a time. This cycle of switching from one nostril to another occurs about every four hours and is a normal human physiological process.
The symptoms of a nasal congestion may include an itchy, tingling, or burning sensation inside the nasal passages. Of course, the most obvious symptom is the gradual increase of stuffiness or blockage to the nasal passages. More often than not, nasal congestion itself is considered as a symptom rather than a malady or disease.
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There are many causes of nasal congestion. The following is a list of some of the more common and uncommon causes of nasal congestion:
- Acute sinusitis (sinus infection)
- Allergies and/or hay fever
- Decongestant overuse
- Foreign body in nasal passage
- Vasomotor rhinitis
- Viral upper respiratory infection
- Nasal polyps
- Complications associated with excessive cocaine use
- Side effect or reaction to a medication
Although nasal congestion is often more of a symptom than a disease in itself, there are certain factors that can be considered predispositions to nasal congestion.
Individuals that are prone to frequent sinus infections or upper respiratory infections whether they are bacterial, viral, fungal, or parasitic in nature will often be prone to nasal congestion.
Allergy sufferers can expect bouts with nasal congestion. Of course, not all individuals react to allergens in the same manner, but those who suffer from frequent and ubiquitous allergens (such as dust for example), are more susceptible to developing nasal congestion as a histamine reaction than those who do not suffer from allergies.
Certain anatomical conditions can be considered risk factors for nasal congestion. One of the most common of these is a deviated septum.
A deviated septum can cause nasal congestion in one or both nasal passages or nostrils. This condition is usually even more noticeable if the sufferer has a cold. A deviated septum can be congenital (present at birth) or created due to some physical source such as a sports related injury or nasal inhalation of narcotic drugs.
Another anatomical condition that could be considered as a risk factor for frequent nasal congestion in inflamed nasal polyps or other nasal growths that are benign or malignant. Even enlarged adenoids can be a risk factor for nasal congestion.
Interestingly, prolonged or excessive decongestant use can cause nasal congestion when stopped. This is due to the membranes in the nose trying to return to a normal state and overcompensating along the way. This is often referred to as a “rebound” effect.
Most cases of nasal congestion are not serious health conditions or life threatening. However, if nasal congestion is accompanied by any of the following symptoms you should seek professional medical advice as soon as possible:
- Frequent or severe nose bleeding
- Changed appearance or deformation of the bones of the face
- Decreased vision or double vision
- Loose teeth or an upper denture that once fit properly but doesn’t now
- Facial numbness or dental numbness
- Any pain, swelling, or inflammation around the nose, forehead, or eyes
It is difficult to prevent nasal congestion without knowing the causal factors responsible for creating the condition. However, there are some steps that can be taken to reduce the risk factor or at least reduce the frequency of nasal congestion.
Individuals with allergies should try to avoid allergens as much as possible. In addition, allergy immunotherapy (allergy shots) may help prevent nasal congestion due to allergic responses. Avoiding irritants (such as cigarette smoke, chemicals, etc.) may also prevent bouts of nasal congestion.
Nasal congestion is easy to diagnose, however determining the underlying cause may be more difficult. Your physician will be able to determine the cause of your congestion upon a physical examination. Normally, a primary care physician will examine your nose with a nasal speculum or otoscope and a penlight.
However, this procedure cannot provide a comprehensive view of the entire nasal passage, but is often all that is needed to make an accurate diagnosis. If the primary care physician has suspicion to think that the nasal congestion is caused from a situation that requires a more comprehensive diagnostic procedure, the may refer the patient to an otolaryngologist or ear, nose and throat (ENT) physician.
In addition to the above mentioned diagnostic procedure, an ENT may order a CAT scan (Computerized Axial Tomography) of the sinuses or may perform an endoscopic examination. A CAT scan will provide x-ray views in slices or cross sections of the sinuses and nasal passages providing a detailed view of the area. An endoscope is basically a narrow tube with a camera on one end that allows the ENT physician to look deeply into the nasal passages.
If a physician has reason to believe a stuffed up nose is caused by a bacterial, viral, or fungal infection, a sample culture swab may be taken to determine the exact cause of the infection.
Nasal congestion can be treated in a variety of ways including non-pharmaceutical, pharmaceutical, and herbal options. Non-pharmaceutical treatment (sometimes called home remedies) for nasal congestion is often desired when pharmaceutical methods could cause undesirable side affects or the condition does not respond well to pharmaceutical therapy.
Thinning the mucous can often relieve nasal congestion or at least make breathing easier. Methods for thinning the mucous in the nose can include the following:
- Drink plenty of fluids. Warm drinks such as broth and tea for example may help by not only providing fluid but by warming the nasal passages.
- Use a gentle over-the-counter saline (salt water) spray or a neti pot.
- Increase the ambient humidity of the air around you by using a vaporizer or humidifier.
Keeping the head in an upright position may be helpful as well. Nasal congestion often increases when the head is in a prone or supine position.
Try using adhesive strips to widen the nasal passages. Most pharmacies sell a plastic adhesive strip that is place on the nose. Although it will not cure the underlying cause of nasal congestion, the adhesive strips work by helping to enlarge the nasal passages making breathing easier.
Inhalers may be helpful in relieving nasal congestion. Inhalers can be commercially manufactured or inhalation therapy can be performed by pouring hot water in a bowl and inhaling the steam vapors that rise off from it. Many herbal agents can be used as inhalants. Eucalyptus oil, peppermint oil, spearmint oil, and menthol are just a few that have proven successful for many people. Even the smell of a freshly cut onion can have powerful decongestant effects.
Pharmaceutical Treatment Options
Pharmaceutical treatment options for nasal congestion are numerous. Pharmaceutical therapies available for congestion can be classified into over-the-counter and prescribed chemical therapies. Regardless of the pharmaceutical that is used, there are basically two methods of action by the chemical agent.
Most chemicals are either an antihistamine or a vasoconstrictor. An antihistamine inhibits the effects of histamine in the human body. Histamine is produced as an allergic reaction to an allergen; it triggers a response of inflammation. By blocking or reducing the effect of histamine an antihistamine in effect blocks or reduces the inflammation response preventing the nasal passages from becoming congested.
A vasoconstrictor shrinks the blood vessels. Nasal decongestant vasoconstrictors cause the blood vessels lining the nasal passages to shrink, thereby relieving congestion. Nasal decongestants and antihistamines can be administered orally (pill, tablet, or capsule) or can be in the form of a nasal spray.
Over-The Counter (OTC) Pharmaceuticals
The following is a list of the more common over-the-counter oral antihistamines that may be useful for treating nasal congestion:
- Diphenhydramine – known as trade names Benadryl or Dimedrol
- Chlorpheniramine – known as trade names Chlor-Trimton, Chlor-tripolon, Piriton and HISTA-12
- Pheniramine – often combined with other drugs. Maybe known by the trade name Avil
- Pyrilamine – known as trade names Phena-Plus, R-Tannate
- Phenindamine – known as trade name Nolahist
- Loratadine – known as trade names Claritin, Alavert
- Cetirizine – known as trade name Zyrtec
Most oral antihistamines share the same list of possible side effects, however some specific chemicals may have side effects that are particular to that drug. Almost all antihistamines share a common side effect of drowsiness; however loratadine and cetrizine have demonstrated lower percentages of patient somnolence than many of the other antihistamines listed. Additional side effects from anithistaimes can include dizziness, headache, loss of appetite, stomach upset, vision changes, and dry mouth.
Common OTC Medicine
If you have any questions about whether an over-the-counter medicine is right for you, or about what potential harmful side effects they could cause it is best to seek professional medical advice.
The following is a list of the more common over-the-counter oral decongestants that may be useful for treating nasal congestion:
- Pseudoephedrine – known as trade name Sudafed
- Phenylpropanolamine – known as trade name Dexatrim or Accutrim. Phenylpropanolamine also known as PPA, was discontinued for over-the-counter sale in the United States in 2005 by the U.S. Food and Drug Administration (FDA). However, it is still available as an OTC drub in other countries and may be know as Wick DayMed (Europe) and Alerid-D and D-Cold Total (India)
- Phenylephrine – although phenylephrine is usually not sold alone, it is one of several ingredients often found in OTC cold/flu remedies. In fact with the curtailment of pseudoephedrine use in the U.S. due to methamphetamine use, phenylephrine has become the most popular decongestant.
Some of the combination remedies with phenylephrine include:
- Robitussin CF
- Dayquil Capsules
- Execedrin Sinus Headache
- Sudafed PE, Codral
- Dimetapp PE
- Neo Citran
Both pseudoephedrine and PPA are vasoconstrictors. They cause the blood vessels in the lining of the nasal passages to shrink; however, they do not specifically target these blood vessels. They may cause any of the body’s blood vessels to shrink. Normally this is not significant but can result in tachycardia, difficulty sleeping, tremors or shakiness, dizziness, and unusual weakness. PPA particularly was removed from OTC sale by the FDA in 2005 due to the possibility of stroke when used by young women.
As with the antihistamines, if you have any questions about whether an over-the-counter medicine is right for you, or about what potential harmful side effects they could cause it is best to seek professional medical advice.
There are primarily two OTC nasal decongestant sprays. These chemicals are sprayed directly into the nasal passages where they contact the tissue and topically employ a vasoconstrictor to shrink the nasal membranes. The two common nasal decongestant sprays are:
- Oxymetazoline – known as trade names Vicks Sinex, Afrin, Dristan, Sudafed OM, and Mucinex Full Force
- Phenylephrine – Neo-Synephrine
Side effects from nasal decongestant sprays not only include those already listed above for oral nasal decongestants but may also include burning, stinging, sneezing, and increased nasal discharge, excessive drying of the nostrils, and altered taste sensations.
As for the OTC solutions, prescriptions medications follow the same parallel. That is, most prescriptive medications for nasal decongestants are either antihistamines, decongestants, or a combination of the two in either oral or nasal spray forms. Some of these may even be the same medications, but under a medical prescription authorization, the concentration of the key ingredient may be changed.
A few of the prescriptive oral antihistamines that may be effective in treating nasal congestion include:
- Desloratadine – known as trade name Clarinex
- Levocetirizine – known as trade name Xyzal
- Fexofenadinie – known as trade name Allegra
Prescription oral decongestants are normally the same as the OTC types except they may be dispensed at a different dosage and are often combined with other chemicals (such as antihistamines) that are prescriptive. For example, Allegra-D is a prescriptive formula containing time released fexofenadine and pseudoephedrine.
Leukotriene Receptor Antagonist
A different approach to allergy control that may also reduce nasal congestion is an oral medication known as a leukotriene receptor antagonist. Montelukast also known as Singulair is designed to prevent and manage asthma and also relieve symptoms of seasonal allergies including nasal rhinitis or nasal congestion.
Finally there is one other approach to controlling nasal congestion by the use of prescription medication and that is by the use of an intranasal steroid or INS. These steroids combat nasal congestion by inhibiting the inflammation response of the nasal passage but not by vasoconstriction. Instead these corticosteroids inhibit the immune system’s ability to the inflammation reaction. These medications are normally administered as nasal sprays and may include the following:
- Ciclesonide – known as trade name Omnaris
- Fluticasone Proprionate – known as trade name Flonase
- Fluticasone Furoate – known as trade name Vermyst
- Budesonide – known as trade name Rhinocort
- Beclomethasone Diproprionate Monohydrate – known as trade name Beconase AQ
- Mometasone Furoate Monohydrate – known as trade name Beconase AQ
- Triamcinolone Acetonide – known as trade name Nasacort AQ
- Flunisolide – known as trade name Nasarel
Side effects from these medications are rarely serious but may include a burning or stinging sensation in the nose, altered taste sensation, nosebleeds, nasal perforations, and (rarely) slowed growth of children.
Medical Treatment Considerations
Medicinal treatment options costs are as varied between medications as well as their purchase location. In addition, generic medications generally are cheaper than name brands, if the generic version is available.
If you suffer nasal congestion that lasts longer than two weeks or that does not respond to normal OTC medication, it is best to seek professional medical advice. Only your doctor can make an accurate diagnosis of the underlying cause of your nasal congestion and recommend the corrective action necessary to relive the situation.