Nasal Congestion

Nasal congestion or stuffy nose is a very common complaint caused by swelling and accumulation of fluid in nasal tissues. Congestion of nasal cavities may or may not be accompanied by a runny nose.

Nasal congestion may cause difficulty in breathing. In some cases, it may make the person feel tired. In small children, it may affect sleeping. Some other symptoms that are commonly seen associated with nasal congestion are a runny nose, sinus pain, the buildup of fluid in the nasal cavities, and swelling in the nasal tissues.

Home treatment is the best way to alleviate nasal congestion. It may affect people of any age and can be acute or chronic. The chronic form of nasal congestion is persistent and may affect sleep and breathing.

It is not a disease in itself, although it causes quite a discomfort. Nasal congestion is seen as a symptom of many diseases. Accompanying symptoms depend on the underlying cause of nasal congestion.

Nasal congestion is caused by multiple causes, the most common among them being:

• Infections
• Allergies
• Rhinitis
• Nasal polyps

Nasal congestion may also be caused by:

• Swelling in adenoid glands
• Nasal injuries
• Presence of foreign bodies in nasal cavities
• Tumors
• Certain medications

Common cold and upper respiratory infections lead to stuffy nose along with other characteristic symptoms of the infection. Flu is a viral infection that has a stuffy nose as one of the symptoms along with high fever and exhaustion.

Inflammation of sinuses, the small air-filled spaces in the face, called sinusitis also leads to nasal congestion. Infections are the main causes of sinusitis. Stuffy nose is also caused by an allergy to pollen, a condition called hay fever.

Inflammation of the lining of nasal cavities during allergic rhinitis lead to nasal congestion. Allergic rhinitis may be caused by dust mites, pet dander, latex, flour, wood dust, and certain plants.

Non-allergic causes of rhinitis include smoke, overactive thyroid gland, changes in temperature, stress, pregnancy, and side effects of certain medications. Overuse of nasal decongestants is also implicated in nasal congestion. Fleshy swellings in the nasal cavities called polyps, cause a stuffy nose.

Review of signs and symptoms is the first step in diagnosing the cause of nasal congestion. If conventional treatment does not give relief, one may be referred to an ENT specialist. Further tests and investigations are based on the probable cause of stuffy nose.

Allergy tests and blood tests are commonly suggested. Nasoendoscopy is the procedure used by ENT specialist to identify the cause of congestion. In some rare cases, other imaging techniques may be recommended.

Treating the underlying cause is the best method to control nasal congestion. Many causes of nasal congestion are not serious and may not require any specific treatment for resolving stuffiness. Steam inhalation is a time-tested method to relieve congestion in the nasal cavities.

Saline nasal drops are also useful in clearing blocked nose. Breathing in the vapor of menthol or eucalyptus oil is also used to reduce congestion. These medications are available in the form of rubs or oils.

Decongestant sprays and drops are found to be effective in relieving congestion in the nasal cavities. Decongestants may also be available in the form of tablets and syrups. Steroid sprays are often used for nasal congestion.

The most common causes of nasal congestion are infections, allergies, rhinitis, and nasal polyps.

Common cold – nasal congestion is a symptom of infections like common cold. Stuffy nose is also seen with other upper respiratory tract infections. Other accompanying symptoms include a headache, fever, and cough. The symptoms may resolve with over-the-counter medications like ibuprofen and paracetamol.

Flu – flu is a viral infection with symptoms resembling that of common cold. But it is characterized by high fever and exhaustion unlike that of the common cold. Sneezing, and running nose also may be noted along with nasal congestion.

Sinusitis – sinusitis refers to the inflammation of sinuses, the small air-filled spaces in the face. Sinuses are involved in the production of mucus that drains into the nasal cavities. Sinusitis and nasal congestion may be acute and resolves within few days, while in some cases it may be persistent and develop into chronic sinusitis.

Hay fever – hay fever is caused by allergic reaction to pollen. It is one of the most common causes of a stuffy nose. It may also cause itchy eyes and sneeze.

Rhinitis – inflammation of the lining of nasal cavities is referred to as rhinitis. Rhinitis may be caused by allergic and non-allergic causes. Allergic rhinitis is caused by dust mites, latex, flour, pet dander, pet hair, wood dust, and certain plants.

Many non-allergic causes also lead to rhinitis. Nasal congestion may be caused by exposure to smoke and fumes, hyperthyroidism, changes in temperature, stress, pregnancy, and certain medications.

Beta-blockers, anti-inflammatory painkillers, and some medications used in the treatment of high blood pressure are implicated in the development of rhinitis. Overuse of nasal decongestant sprays may lead to rhinitis. This condition is called as rhinitis medicamentosa. When used for more than few weeks, swelling of the nasal cavities may return.

Nasal polyps – polyps are benign, fleshy growths in the nasal cavities. Nasal congestion is one of the most common symptoms of these growths.

Swelling in adenoid glands – swelling in adenoid glands at the back of the nose may result in the stuffy nose. Adenoid glands may shrink in childhood, but when it is persistent it may cause a runny nose and nasal congestion.

Deviated septum – change in the structure of the nasal septum may also cause stuffiness in the nose. Injury to the face often leads to congestion.

Food allergy – food allergy is an abnormal immune reaction to specific foods. Some types of food allergy may result in the stuffy nose.

Drug addiction or substance use disorder is also characterized by nasal congestion. Pregnancy and stress are also implicated in the development of congestion in nasal cavities.

Hormonal changes, the presence of foreign bodies in the nose, and thyroid disorders also have a stuffy nose as one of the symptoms. Inflammation of blood vessels, called Churg-Strauss syndrome, is a rare disorder that may cause nasal congestion.

If nasal congestion persists for more than ten days, it is better to get the underlying cause diagnosed. The same holds true for congestion that is accompanied by high fever and persists for more than 3-4 days.

Medical attention is warranted if the nasal discharge is green in color and is accompanied by fever and pain in sinuses. People with weakened immune system, asthma, and emphysema should contact a doctor if nasal congestion develops.

Review of signs and symptoms is the first step in the diagnosis of the underlying condition that causes nasal congestion. Physical examination may focus on the structure and functioning of ear, nose, throat, and airways.

In most of the cases, nasal congestion may be treated by a general physician. But if the condition does not respond to conventional treatment and if the cause is not clear, one may be referred to an ear, nose, and throat specialist.

Other tests and investigations may be recommended based on the probable cause of the congestion. Some other tests commonly suggested include allergy tests, blood tests, sputum culture, and imaging studies.

Allergy tests include both skin prick test and blood test for allergens and antibodies. A nasoendoscope enables the ENT specialist to look into the back of the nose for abnormalities that may result in nasal congestion. In some rare cases, CT scan or MRI may be recommended to diagnose the causative factor or congestion.

Treating the underlying cause is the apt method to control stuffiness in the nose. In most of the cases, nasal congestion can be treated by simple home treatments.

Steam inhalation using a kettle or a steam cup helps to alleviate the stuffiness in the nose. A blocked nose can be cleared using saline drops. This solution helps to make the mucus more liquid so that it can be drained easily. 

Rubs and oils containing menthol and eucalyptus oil are available as over-the-counter products to relieve the nasal blockage. Rubs are applied on the chest so that the vapor can be inhaled. Oils are usually used in steam inhalations.

Throat sweets that release a vapor are also suggested to clear the congestion. The sweet helps to soothe a sore throat, while the vapor from the sweet relieves congestion. Decongestants sprays and drops are also indicated in the treatment of nasal congestion.

But these drops and sprays should be used with caution as indiscriminate use may lead to rebound congestion. It should be used only for a maximum of one week. Decongestants are available in the form of tablets and syrups too.

These are thought to be safer than sprays and drops. Nasal congestion caused by allergies and polyps are treated with steroid sprays. These are used directly inside the nose and helps to reduce the swelling within the cavities.

Nasal irrigator, or Neti pot or bulb syringe, uses distilled, sterile water to irrigate the nasal cavities to remove the block. Using a warm, wet towel on the face also helps to relieve the discomfort due to congestion. Using a humidifier or vaporizer is also of help as dry air worsens the symptom.