You and Your Stuffy Nose
Nasal congestion, stuffiness, or
obstruction to nasal breathing is one of man's oldest and most common
complaints. While it may be a mere nuisance to some persons, to others it is a
source of considerable discomfort, and it detracts from the quality of their
Medical writers have classified the causes of nasal obstruction into four
categories, recognizing that overlap exists between these categories and that it
is not unusual for a patient to have more than one factor involved in his
An average adult suffers a common "cold" two to three times per year, more
often in childhood and less often the older he gets as he develops more
immunity. The common "cold" is caused by any number of different viruses, some
of which are transmitted through the air, but most are transmitted from
hand-to-nose contact. Once the virus gets established in the nose, it causes
release of the body chemical histamine, which dramatically increases the blood
flow to the nose -- causing swelling and congestion of nasal tissues -- and
which stimulates the nasal membranes to produce excessive amounts of mucus.
Antihistamines and decongestants help relieve the symptoms of a "cold," but time
alone cures it.
During a virus infection, the nose has poor resistance against bacterial
infections, which explains why bacterial infections of the nose and sinuses so
often follow a "cold." When the nasal mucus turns from clear to yellow or green,
it usually means that a bacterial infection has taken over and a physician
should be consulted.
Acute sinus infections produce nasal congestion, thick discharge, and pain
and tenderness in the cheeks and upper teeth, between and behind the eyes, or
above the eyes and in the forehead, depending on which sinuses are involved.
Chronic sinus infections may or may not cause pain, but nasal obstruction and
offensive nasal or postnasal discharge is often present. Some persons develop
polyps (fleshy growths in the nose) from sinus infections, and the infection can
spread down into the lower airways leading to chronic cough, bronchitis, and
asthma. Acute sinus infection generally responds to antibiotic treatment;
chronic sinusitis usually requires surgery.Structural
Included in this category are deformities of the nose and the nasal septum,
which is the thin, flat cartilage and bone that separates the nostrils and nose
into its two sides. These deformities are usually due to an injury at some time
in one's life. The injury may have been many years earlier and may even have
been in childhood and long since forgotten. It is a fact that 7 percent of
newborn babies suffer significant nasal injury just from the birth process; and,
of course, it is almost impossible to go through life without getting hit on the
nose at least once. Therefore, deformities of the nose and the deviated septum
should be fairly common problems -- and they are. If they create obstruction to
breathing, they can be corrected with surgery.
One of the most common causes for nasal obstruction in children is
enlargement of the adenoids: tonsil-like tissues that fill the back of the nose
up behind the palate. Children with this problem breath noisily at night and
even snore. They also are chronic mouth breathers, and they develop a "sad" long
face and sometimes dental deformities. Surgery to remove the adenoids and
sometimes the tonsils may be advisable.
Other causes in this category include nasal tumors and foreign bodies.
Children are prone to inserting various objects such as peas, beans, cherry
pits, beads, buttons, safety pins, and bits of plastic toys into their noses.
Beware of one-sided foul smelling discharge, which can be caused by a foreign
body. A physician should be consulted.Allergy
Hay fever, rose fever, grass fever, and "summertime colds" are various names
for allergic rhinitis. Allergy is an exaggerated inflammatory response to a
foreign substance which, in the case of a stuffy nose, is usually a pollen,
mold, animal dander, or some element in house dust. Foods sometime play a role.
Pollens cause problems in spring (trees) and summer (grasses) or fall (weeds)
whereas house dust allergies and mold may be a year-around problem. Ideally the
best treatment is avoidance of these substances, but that is impractical in most
In the allergic patient, the release of histamine and similar substances
results in congestion and excess production of watery nasal mucus. Antihistamine
helps relieve the sneezing and runny nose of allergy. Many antihistamines are
now available without a prescription. The most familiar brands include
Chlor-Trimeton®, Benadryl®, or Dimetane® (although most are also available in
generic forms). Newer, nonsedating antihistamines, which require a prescription
include Claritin®, Zyrtec®, and Allegra®. Decongestants shrink congested nasal
tissues. Examples include Sudafed®, Guaifed®, and Entex® that are available
without a prescription in several generic forms. Combinations of antihistamines
with decongestants are also available. All these preparations have potential
side effects, and patients must heed the warnings of the package or prescription
insert. This is especially important if the patient suffers from high blood
pressure, glaucoma, irregular heart beats, difficulty in urination, or is
Allergy shots are the most specific treatment available, and they are highly
successful in allergic patients. Skin tests or at times blood tests are used to
make up treatment vials of substances to which the patient is allergic. The
physician determines the best concentration for initiating the treatment. These
treatments are given by injection. They work by forming blocking antibodies in
the patient's blood stream, which then interfere with the allergic reaction.
Many patients prefer allergy shots over drugs because of the side effects of the
Patients with allergies have an increased tendency to develop sinus
infections and require treatment as discussed in the previous
''Rhinitis" means inflammation of the nose and nasal membranes. "Vasomotor"
means blood vessel forces. The membranes of the nose have an abundant supply of
arteries, veins, and capillaries, which have a great capacity for both expansion
and constriction. Normally these blood vessels are in a half-constricted,
half-open state. But when a person exercises vigorously, his/her hormones of
stimulation (i.e., adrenaline) increase. The adrenaline causes constriction or
squeezing of the nasal membranes so that the air passages open up and the person
breathes more freely.
The opposite takes place when an allergic attack or a ''cold'' develops: The
blood vessels expand, the membranes become congested (full of excess blood), and
the nose becomes stuffy, or blocked.
In addition to allergies and infections, other events can also cause nasal
blood vessels to expand, leading to vasomotor rhinitis. These include
psychological stress, inadequate thyroid function, pregnancy, certain anti-high
blood pressure drugs, and overuse or prolonged use of decongesting nasal sprays
and irritants such as perfumes and tobacco smoke.
In the early stages of each of these disorders, the nasal stuffiness is
temporary and reversible. That is, it will improve if the primary cause is
corrected. However, if the condition persists for a long enough period, the
blood vessels lose their capacity to constrict. They become somewhat like
varicose veins. They fill up when the patient lies down and when he/she lies on
one side, the lower side becomes congested. The congestion often interferes with
sleep. So it is helpful for stuffy patients to sleep with the head of the bed
elevated two to four inches. Accomplish this by placing a brick or two under
each castor of the bedposts at the head of the bed. Surgery may offer dramatic
and long time relief.Summary
Stuffy nose is one symptom caused by a remarkable array of different
disorders, and the physician with special interest in nasal disorders will offer
treatments based on the specific causes. Additional information and suggestions
can be found in the AAO-HNS pamphlets "Hayfever, Summer Colds and Allergies" and
© 2004 AAO-HNS/AAO-HNSF
Please read our disclaimer. Any information provided on this Web site should not be considered medical advice or a substitute for a consultation with Dr. Hector N. Hernandez or other healthcare professional. If you have a medical problem, contact us for diagnosis and treatment.