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Nasal or 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 lives.
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 particular case.
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.
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.
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 cases.
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 pregnant.
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 drugs.
Patients with allergies have an increased tendency to develop
sinus infections and require treatment as discussed in the previous
section.
''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.
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 "Antihistamines."
© 2004 AAO-HNS/AAO-HNSF
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