Nasal congestion

Definition

Many people think that a nose gets congested (stuffy) from too much thick mucus. This is incorrect. A congested nose happens when the membranes lining the nose become swollen from inflamed blood vessels.

Congestion can be caused by many of the same things that cause a runny nose including colds, allergies, sinus infections, and the flu. Overuse of some nasal sprays or drops can also lead to congestion.

Considerations

A stuffy nose is usually caused by a virus and typically goes away by itself within a week.

Newborn infants 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 breathing problems. Nasal congestion in older children and adolescents is usually 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 episodes of not breathing during sleep (sleep apnea).

In children, nasal congestion from enlarged adenoids has caused chronic sleep apnea with insufficient oxygen levels and right-sided heart failure. The problem usually goes away after surgery to remove the adenoids and tonsils.

Common Causes

• Common cold or the flu -- often accompanied by a clear, watery discharge plus fever, cough, headache, joint aches, muscle aches, or sore throat
• Hay fever -- often accompanied by a clear, watery discharge, itching eyes, and sneezing
• Sinus infection -- often accompanied by thick, cloudy, yellow-green nasal discharge, and pain or tenderness around eyes and cheekbones that worsens when bending the head forward
• Vasomotor Rhinitis -- is a term used for nasal symptoms that aren't caused by bacteria, viruses, or allergies, but by irritants such as dry air or pollution. The symptoms can usually be helped by saline nasal spray/drops or nasal steroids, or by avoiding the irritating substance.

Home Care

To relieve a runny or stuffy nose, the following over-the-counter medicines may help:

• Decongestants– these may help relieve congestion by shrinking the blood vessels in the lining of the nose. They only help with stuffiness, not a runny nose or other symptoms. Decongestant nasal sprays and drops should not be used for more than 3 days, because then they can make the congestion worse.
• Antihistamines– these may reduce the amount of mucus. Be careful, because some antihistamines make people drowsy.

These medicines can make breathing more comfortable, but do not treat the underlying condition. Many over-the-counter allergy and cold medicines contain multiple ingredients, so look carefully to see what is in the one you choose.

Medicines are not the only way to relieve a stuffy or runny nose. Often, gentler solutions are better. Try these steps to thin the mucus, which can help you breathe easier and get your nasal secretions back to normal:

• Use gentle saline nasal sprays.
• Increase the humidity in the air with a vaporizer or humidifier.
• Drink extra fluids. Hot tea, broth, or chicken soup may be especially helpful.

For a baby too young to blow his or her nose, an infant nasal aspirator (bulb) can help remove the mucus. If the mucus is thick and sticky, loosen it by putting 2 or 3 saline nose drops into each nostril. Don't insert cotton swabs into a child's nostrils. Instead, catch the discharge outside the nostril on a tissue or swab, roll it around, and pull the discharge out of the nose.

Congestion is often worse when you are lying down. Keep upright, or at least keep the head elevated. This is especially helpful for young children.

Pharmacies and supermarkets sell adhesive strips that can be placed on the nose when you are congested. These help widen the nostrils, making breathing easier.

Call your health care provider if

• Your stuffy nose is accompanied by swelling of the forehead, eyes, side of the nose, or cheek.
• You also have blurred vision.
• You have increased throat pain, or white or yellow spots on the tonsils or other parts of the throat.
• Coughing episodes last longer that 10 days.
• The cough produces yellow-green or gray sputum.
• A stuffy nose lasts longer than 2 weeks and significantly interferes with your life.

What to expect at your health care provider's office

Your doctor may perform a physical examination, focusing on the upper respiratory system, ears, nose, and throat.

Your doctor will ask medical history questions, such as:

• When did it develop? Is it always present?
• What have you done to try to relieve the congestion? How well has it worked?
• What other symptoms are also present -- nasal drainage, loss of sense of smell, watery or itching eyes, sneezing, fever, cough, headache, facial pain?

The following diagnostic tests may be performed:

• allergy skin tests (performed only by allergists)
• blood tests (such as CBC or blood differential)
• sputum culture and throat culture
• x-rays of the sinuses and chest x-ray
• serum total IgE (the allergy-related immunoglobin)

Over-the-counter medications may be recommended. Stronger, prescription medications may be advised. For severe hay fever cases, desensitization injections (allergy shots) for known allergens may be administered. Other treatment, including surgery, may be advised depending on the cause.

Illustrations

Throat anatomy

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