Nasal congestion is a well-known symptom for anyone who has suffered from a viral upper respiratory tract infection. The causes of chronic nasal congestion are discussed below.
Causes of nasal congestion
- In children: large adenoids; rhinitis; Choanal atresia; tumors localized in the posterior half of the nasal cavity (in the nasopharyngeal space), for example angiofibromas; foreign bodies.
- In adults: nasal septum defects, rhinitis, polyps, chronic sinusitis, granulomatous lesions (tuberculosis, syphilis, leprosy), iatrogenic effects (use of local vasoconstrictors, reserpine, tricyclic compounds).
Iatrogenic nasal obstruction (medicinal rhinitis)
Medicines (drops and sprays) that reduce congestion in the nasal mucosa due to vasoconstriction can lead to damage to the mucous membrane due to hypoxia. In this case, a “ricochet phenomenon” often occurs, manifested by stagnation of blood in the mucous membrane, which leads to even greater swelling, forcing the patient to increase the use of the drug. The nasal mucosa becomes swollen and red.
Please note: such decongestants cannot be used for longer than 1 week.
nasal allergy
It can be seasonal or last all year round.
Symptoms: sneezing, itchy nose and rhinorrhea. The turbinates are swollen and the mucous membrane is pale or mauve. Nasal polyps are common. The allergen can be identified using skin tests.
Therapeutic courses of injections of desensitizing drugs can help 70% of patients with seasonal allergic rhinitis, but only 50% of patients suffering from allergies to house dust mites. This treatment can also cause fatal anaphylaxis, so such patients need medical supervision for some time after each desensitizing injection, and everything necessary for cardiopulmonary resuscitation should be on hand. Other treatment options include the use of antihistamines [eg, Terfenadine 60 mg every 12 hours orally], general decongestants [eg, pseudoephedrine (Pseudoephedrin) 60 mg every 12 hours orally, side effects – hypertension, hyperthyroidism, exacerbation of coronary artery disease; simultaneous use of MAO inhibitors is contraindicated); sprays (for example, 2% sodium chromoglycate solution, 2 “exhausts” of 2,6 mg every 4-6 hours) or nasal steroid therapy (for example, beclomethasone dipropionate, 8 inhalations of 50 mcg during the day).
Note: Steroid nasal inhalers can be used continuously, but steroid drops are easily absorbed and have a general effect on the body, so they can be used for no longer than 1 month per course of treatment, with no more than 1 courses of treatment per year.
Vasomotor rhinitis
It also causes nasal obstruction and/or rhinorrhea. Identifying the allergen is usually difficult. During rhinoscopy, swollen and edematous nasal turbinates are visible, and excess mucus production is noted.
Treatment: Conventional measures taken for allergic rhinitis are ineffective. Rhinorrhea is treated with ipratropium in the form of a nasal aerosol (2 inhalations of 20 mcg in each nostril every 6 hours). Nasal congestion can be relieved by cauterization or surgical reduction of the inferior turbinate.
nasal polyps
Nasal polyps are commonly found in association with allergic rhinitis, chronic ethmoiditis, and cystic fibrosis. For such patients, an aerosol of beclomethasone dipropionate can be recommended, for example, S “exhausts” per day (one “exhaust” = 50 mcg). Otherwise, polygoctomy is necessary.
Deviated septum
It is rare in children, but in adults it affects up to 20% of the population. A deviated nasal septum may be secondary to trauma to the nose. The deformity is corrected by surgically removing a strip of bone and cartilage from the nasal septum, called submucosal resection (SMR).
Diagnosis of nasal congestion
First of all, it is necessary to carefully collect anamnesis: how variable the symptoms are, the nature of the obstruction of the nostrils, the effect of nasal congestion on eating, speech and sleep (snoring). When examining the patient, you should pay attention to any abnormalities on the part of the nose, its curvature, whether both nostrils are completely closed (to do this, you should hold the nasal speculum under each nostril in turn and observe the mirror fogging); The nasopharyngeal space is examined using a mirror (in children it is better visualized on a lateral x-ray).