A blocked nose, nasal congestion or a stuffy nose is a common ailment that we will all experience in our lifetimes. That bunged-up feeling in our sinuses, forcing us to breathe through our mouths can be a hindrance on our day-to-day lives, and can be accompanied by excessive mucus or catarrh, headaches, or a stuffy feeling in the head, a red and sore nose, and an impairment in smell and taste.
1. The common cold and viral upper respiratory infection
Of course, one of the major culprits is the common cold. It can be caused by many different virus strains – particularly rhinoviruses – that manifest in the classic symptoms of a sore throat, sneezing, coughing, headaches, high temperature, feelings of pressure in the ears and face, and, of course, a runny and/or blocked nose. Colds are rarely serious, although there is no cure or vaccine, and antibiotics are ineffective. The symptoms can be treated with rest, paracetamol, and perhaps a decongestant, and these infections are self-limiting with resolution within 10 days or so being the rule.
Allergies are caused by the reaction of the body’s immune system to a foreign substance – basically the immune system thinks the substance is dangerous and creates an inflammatory response to get rid of it. On exposure to the allergic trigger, chemical substances are released in the nose including histamine, which causes mucus secretion, mucosal engorgement and sneezing. The severity of the reaction can be varied, from mild nasal congestive symptoms to complete nasal obstruction. Allergic rhinitis may be seasonal and occur during the spring and summer (hay fever), or year round (perennial allergic rhinitis) and usually due to house dust mite and other triggers such as animal dander. Specific allergens causing symptoms can be identified with skin prick tests or blood tests, which will help in guiding treatment.
3. Nasal polyps
Benign (non-cancerous) growths in the nostrils, nasal polyps can develop due to chronic inflammatory reaction in the mucous membranes lining the nose and sinuses. The nasal linings humidify the air passing in and out of your nose, and protect the interior of the nose and sinuses. Some people may develop polyps with no apparent cause, but frequently there is a trigger, such as asthma, hay fever, chronic or recurring sinus infections, or sensitivity to NSAIDS (non-steroidal anti-inflammatory drugs), like ibuprofen. Nasal polyps can grow large enough to block the nasal passages, causing congestion, or the sensation of a blocked nose, loss of smell, and sometimes sinusitis. Polyps can be diagnosed easily in the clinic, sometimes requiring the help of a simple endoscopic examination of the nose. There are a number of medications that your doctor may prescribe to counter the causes or symptoms of polyps, and if these don’t work, there is a surgical option to have them removed.
Sinusitis, or sinus infection, is a common condition, in which the nasal passages become inflamed. The nasal sinuses are small cavities or spaces within the skull located behind the cheeks, in the forehead, and between and behind the eyes. The sinuses all open into the nasal cavities. Colds and allergies can cause excess mucus and swelling of the mucosal lining which blocks the sinuses, causing the congestive sensation of a blocked nose.
Acute sinusitis often occurs with or after a cold, and typically lasts a week or two if caused by a virus, or up to four weeks if caused by bacteria. Sub-acute and chronic sinusitis can last for months, depending on the type of infection. If headache and congestion persists, a simple nasal endoscopy can usually identify and confirm sinusitis. Medical treatment is frequently successful in treating chronic sinusitis, but occasional the sinuses need to be opened and drained with surgery known as endoscopic sinus surgery. Recently introduced balloon sinuplasty techniques may be useful in opening the narrow drainage channels to restore normal function.
5. Deviated nasal septum.
A common cause of nasal obstruction which happens when the partition between the sides of the nose, the nasal septum, is bent or deviated to one side or the other. This can result in both sides of the nose feeling blocked. It is commonly, but not necessarily, caused by an injury at some point to the nose. It is usually clear from a simple or endoscopic examination if this is the cause, and, if severe enough, it may warrant surgery to realign it and restore the nasal airway.
6. Rhinitis Medicamentosa
This is an increasingly seen cause of nasal obstruction and a further cause of obstruction which is worth mentioning here. Chronic use of over-the-counter nasal decongestants can cause damage to the lining of the nose with obstruction resulting from the repeated use of these sprays. Once the spray wears off in the early days of use, rebound congestion and blockage results in the need to use more decongestant, and over time this ‘vicious circle’ causes damage to the lining and persistent blockage.
Frequently more than one of the above conditions will coexist for example a patient with allergic rhinitis may have a deviated septum, which in turn may make them more vulnerable to protracted episodes of sinusitis.