Dr. Nikhil Mali

Nasal congestion is the blockage of the nasal passages usually due to membranes lining the nose becoming swollen from inflamed blood vessels

It is also known as nasal blockage, nasal obstruction, blocked nose, stuffy nose, or stuffed up nose.

Nasal congestion can interfere with the ears, hearing, and speech development. Significant congestion may interfere with sleep, cause snoring, and can be associated with sleep apnea.

Nasal congestion can also cause mild facial and head pain, and a degree of discomfort.

Nasal blockage can be seen in the following Diseases

Common cold The onset is acute, with a scratchy sore throat and cough. The nasal mucosa will appear red, boggy, and glassy. The nasal drainage will initially be clear but will later becomecolored (yellow-green). 

Allergic rhinitis

Acute allergic rhinitis is often associated with eye irritation, paroyxms of sneezing,itching of the eyes, nose, or palate, and postnasal drip with cough.

The nasal mucosa is bluishand pale. Seasonal rhinitis is usually caused by inhaled pollens. Perennial rhinitis is caused byallergy to animals, dust, mites, or mold.

VasomotorrhinitisCongestion is prominent, but rhinorrhea, sneezing, and itching are not.

Rhinitis medicamentosa occurs after 3 to 4 days of continuous use of a topical vasoconstrictor.

There will be initial relief with its use that is then followed by rebound with worsened congestion.

Vasomotor rhinitis may also be precipitated by cold, emotion, or sexual arousal. The turbinates are red andboggy.

 

Nasalpolyp Unilateral airflow will be obstructed and a polyp will be visible deep inside, beyond theturbinate, as a gray structure with the appearance of a skinned grape.There is an associationbetween aspirin use, nasal polyps, and asthma, but the most common cause is chronic allergicrhinitis.

Sinusitis

Drainage, if present, will be purulent, although colored drainage can be found in otherconditions.

There will be a sensation of facial fullness that worsens with bending forward, oftenaccompanied by fever and a headache.

On physical examination, there will be tenderness toconcussion and pressure, overlying warmth, and fever. The affected sinus will not transilluminate.

Drugs

Cocaine, beta-blockers, reserpine, and hydralazine can each cause nasal obstruction

Deviated septum

Deviation causes chronic unilateral obstruction, which is readily observed with anasal speculum.

Intranasal foreign body

There will be nasal obstruction associated with a chronic

unilateralmucopurulent discharge with a

foul odour.

SarcoidosisSarcoidosis

presents with bilateral nasal congestion in as many as 20% of cases. Systemic symptoms such as fever, fatigue, or weight loss;

pulmonary symptoms such as cough ordyspnea; or skin manifestations such as erythema nodosum or purple, waxy plaques are clues tothe underlying diagnosis.

Cerebrospinal fluid leak

Head trauma with a basilar skull fracture may go unrecognized.

Clear nasal drainage tests positive for glucose using a urine dipstick.

 

Wegener granulomatosis

Its earliest manifestation may be nasal obstruction, rhinorrhea, crusting,and chronic sinusitis with a fetid drainage. Development of a septal ulceration is present

Causes of Nasal blockage

oAllergic reactionoCommon cold or influenzaoDeviated septumoHay fever, allergic reaction to pollen or grassoReaction to medication (e.g. Flomax)oSinusitis or sinus infection

Treatment

The treatment of nasal congestion frequently depends on the underlying cause.

Both influenza and the common cold are self limiting conditions that improve with time; however, drugs such as acetaminophen (paracetamol) and ibuprofen may help with the discomfort.

A cause of nasal congestion may also be due to an allergic reaction caused by hay fever, so avoiding allergens is a common remedy if this becomes a confirmed diagnosis.

Antihistamines and decongestants can provide significant symptom relief although they do not cure hay fever.

Topical decongestants should only be used by patients for a maximum of 3 days in a row, because rebound congestion may occur in the form of rhinitis medicamentosa

The use of nasal irrigation may help reduce nasal congestion. It involves rinsing the nasal cavity with salty water, however, this may cause further irritation.

VaporisersThese are obtainable in ointment and oil form and have scented constituents that could assist in allaying a dripping nose or finding relief from the ‘stuffed or suffocated feeling’ by de-clogging the inflammation in the air passages. Eucalyptus and oils like peppermint, menthol, camphor act on the nasal receptors, constrict the flow of blood and hence lower inflammation.

Menthol-based nasal strips

The placing of these strips is done below the nasal bridge for allaying obstruction as it lifts open the nostrils. The menthol helps to relieve inflammation in the air passages.. Their strong-smelling nature helps to infiltrate the mucus obstruction, thus help to provisionally open the nasal passages.

Nasal Sprays

These sprays have decongestants like oxymetazoline or xylometazoline that contract the blood vessels. They additionally aid in stopping mucous formation

list of surgical procedures is shown below. •Turbinectomy

•Partial turbinectomy

•Submucosal resection of the turbinates

•Surface "scoring" techniques

•Less invasive techniques

•"Hot poker" methods (electrocautery, radiofrequency, laser)

•Powered/submucous inferior turbinoplasty

•FESS (Functional Endoscopic Sinus Surgery)Septoplasty

According to Ayurveda

नासावरोध

नासाप्रतीनाह

Samprapti:

कफव्रुतो वायुरुदानसंदन््यो यदा स्वमार्गे� विवर्गेुणः स्थि�तःस्यात्।घ्राणं व्रुणोतीव तदा स रोर्गेो नासाप्रतीनाह इती प्रदिदष्टः॥

सु.उ.२२/१५

Laxanas

नासावरोध सकष्टश्वसनमुखेन श्वसन तालुशुष्कता

Chikitsa स्नेहपानस्निस्नग्ध धूमशिशरोबस्तिस्तस्नेहन स्वेदनादिद उपचार्

अपीनस

Samprapti:

कफपरवरधदो नaसायां रुध्द्वा स्रोतांस्यपीनसम्।कुया<त्सघुघु<रं् श्वासं पीनसाधिधकवेदनम्॥

 

नासावरोध, घुघु<रं श्वास, विपस्थि@ल पीत पक्व स्राव

 

Chikitsa

स्नेहन, स्वेदन, वमन, विवरेचन, धूमपान, अवपीडन नस्य

नासाशोष

शोषयेन्नाशिसकास्रोत्ः कफं च कुरुते अविनलः।शुकपुण<भनासात्वं.........॥

वा.सु.

१९/१६

Samprapti:

Laxanas

नासावरोधनासाशुष्कतासकष्टश्वसन, नासाविवदारणशुकपुण<भनासत्वं

Chikitsa

स्नेहपान, स्निस्नग्ध धूम स्वेदनादिद उपचार्

 

पुटक

Samprapti:

विपत्तशे्लष्मावरुधः अतना<सायां शोषयेन्मरुत्।कफं सशुष्कपुटताम् प्राप्नोवित पुट्कं् तु तत् ॥

वा. उ. १९/२५

Laxanas

पुटकोत्पत्तित्त नासावरोधनासाशुष्कता सकष्टश्वसन

 

Chikitsa

स्नहपन सनर्गेध धूम प्रधमन नस्यनाडीस्वेद

नासाश< 

Samprapti:

दोषैस्निस्Oत्तिभस्तैः पु्रथकश्च ब्रुयात्तथः अशा<शिस तथैव शोफाम्।

सु.उ.२२/१८

Laxanas

नासावरोध सकष्टश्वसन शिशरःशूल सानुनाशिसकउच्चार

Chikitsa

शस्Oकम<

प्रवितश्याय

Samprapti:

चयं र्गेता मूधा<विन मारुतादयः प्रुथकसमस्ताश्च तथैव शोत्तिणतम्।

प्रकोप्यमाणां विवविवधैः प्रकोपणैन्रुणां प्रवितश्यायकरा भवन्तिन्त विह॥

सु.उ.२४/४

Chikitsa

स्नेहन स्वेदनवमन धूम र्गेण्डूष

Dr. Nikhil Mali