How to Relieve Nasal Congestion?

Nasal Congestion occurs when the normal breathing organ, the nose, struggles to function properly. The nose is essential for warming, humidifying, and filtering the air we breathe, removing foreign substances, allergens, and microorganisms. Warm and humidified air allows oxygen to transfer into the blood more efficiently when reaching the lungs.

During breathing, the resistance created by airflow in the nose aids in the optimal expansion of the lower airways and lungs (naso-pulmonary reflex).

The key structures responsible for these functions are the inferior nasal turbinates (lower conchae). These structures, rich in vascular tissue, regulate the warming, humidification, and filtering levels of the inhaled air while adjusting the airflow resistance.

Any growth in these turbinates (turbinates hypertrophy), caused by various factors, disrupts this delicate balance and leads to nasal congestion, one of the most common causes of obstructed airflow.

Due to the critical roles of the nose in normal body functions, interventions involving the inferior nasal turbinates should be approached with caution. These structures should only be reduced to ensure normal functionality and not completely removed, except in special cases.

Breathing through the mouth due to nasal congestion reduces oxygen absorption efficiency in the lungs, leading to decreased oxygen levels in the blood.

Low oxygen saturation in the blood is detected by sensors in the brain and its arteries, triggering reflexes that, over time, can cause increased blood pressure (hypertension), heart rhythm issues, or heart failure.

Nasal congestion also results in frequent throat infections, dryness-related complaints, sleep disturbances, snoring, and sleep apnea, significantly reducing the quality of life.

Common Causes of Nasal Congestion in Adults:

  • Deviation of the nasal septum (septum deviation) — the cartilage and bone structure dividing the nasal passages is curved to one side.
  • Problems in the nasal valve area (nasal valve insufficiency), located near the nasal passage entrance.
  • Enlargement of nasal turbinates (turbinates hypertrophy).
  • Injuries or unnoticed traumas during growth can lead to abnormal septum development, causing septum deviation over time.
  • Nasal valve insufficiency may occur due to:
  • Internal insufficiency: Septal deviation narrowing the valve region.
  • External insufficiency: Weak nasal cartilage unable to withstand airflow resistance, often caused by structural issues or surgical reduction for cosmetic purposes.

Nasal valve insufficiency can be evaluated during examination or objectively measured using acoustic rhinometry, which calculates cross-sectional areas in nasal passages. Patients with septum deviation often show compensatory enlargement of the turbinates in the opposite nasal passage to maintain normal function.

Allergic swelling in the nasal mucosa is another common cause of congestion. Patients with allergic rhinitis experience symptoms like nasal itching, sneezing, and watery nasal discharge in addition to congestion.

Other causes of nasal blockage include sinus infections, vasomotor rhinitis (overreaction of nasal vessels to stimuli), nasal polyps from sinuses, enlarged middle turbinates (concha bullosa), and benign or malignant nasal tumors.

In children, the most common cause of nasal congestion is adenoid hypertrophy, which often begins after the age of two. Congenital causes include incomplete formation of nasal canals or choanal atresia, a blockage at the back of the nasal passage. Allergies, sinusitis, and foreign objects in the nose are other possible causes in children.

Nighttime nasal congestion often results from blood pooling in the rich vascular network of the turbinates when lying down. This occurs because gravity helps blood flow back to the heart when upright but diminishes when lying flat, causing swelling of the turbinates.

Diagnostic and Treatment Approaches:

– Infections identified during examination or through imaging should be treated with appropriate medications.
– For allergies, suitable anti-allergic treatments can alleviate nasal congestion.
– In chronic sinusitis and nasal polyps, surgery can be performed to remove polyps, open sinus drainage pathways, and improve ventilation.

Decongestant medications, such as sprays and tablets, are used short-term for nasal infections and allergic reactions. These medications shrink nasal blood vessels, reducing turbinate size and opening the nasal passage.

However, prolonged use (over 5-7 days) of decongestant sprays can lead to rebound congestion and permanent changes in nasal mucosa anatomy. Oral decongestants, effective throughout the body, may cause side effects like palpitations, sleep disturbances, and irritability in children. They are contraindicated for patients with heart rhythm disorders, hypertension, or enlarged prostate due to potential exacerbation of these conditions.

Role of Turbinates in Nasal Congestion:

The simplest method to assess the role of turbinates in nasal blockage is the decongestion test. Applying a decongestant spray and observing a significant improvement within 5-10 minutes suggests turbinate-related blockage.

If congestion persists in one passage despite relief in the other, structural issues like septum deviation should be considered.

Acoustic rhinometry before and after the decongestion test provides numerical insights into the role of turbinate swelling in nasal obstruction.

When allergy or infection is ruled out or controlled through medical treatment but congestion persists, surgical options may be considered.