Nasal congestion

Nasal congestion
Many patients complain about a congested nose, this is a very common symptom and everyone has already experienced such situation. This is, because the nose contains structures, the lower and medial turbinate, which have the ability to expand and shrink. It is a mechanism that is regulated through blood circulation in the nose and gives us the ability to adjust the temperature of the inhaled air and the ability to control the volume and speed of the nasal flow. Some research has revealed that the human nose undergoes cycles of partial swelling of the turbinate where often only the nasal passage on one side is clear. When patients complain about congestion however they are talking about a grade of congestion that has more impact and lasts longer than such natural cycle.

Many patients complain about a congested nose, this is a very common symptom and everyone has already experienced such situation. This is, because the nose contains structures, the lower and medial turbinate, which have the ability to expand and shrink. It is a mechanism that is regulated through blood circulation in the nose and  gives us the ability to adjust the temperature of the inhaled air and  the ability to control the volume and speed of the nasal flow. Some research has revealed that the human nose undergoes cycles of partial swelling of the turbinate where often only the nasal passage on one side is clear. When patients complain about congestion however they are talking about a grade of congestion that has more impact and lasts longer than such natural cycle.

This situation is for various reasons a potentially harmful situation for our life. Firstly an obstruction can also develop through any unclear growth inside the nose. There are various tumors that develop inside the nose. It could be benign polyps, destructive inverted papilloma  or juvenile angio fibroma, or malignant growth like intranasal squamous cell carcinoma,  nasopharyngeal carcinoma or any kind of malignant metastasis in the upper nasal passage.

Another reason why we should be concerned about the congested nose is, that it debilitates the function of our nose which is firstly the breathing. The breathing is one of our most important and from birth to death continuous interactions with our environment. We inhale oxygen and exhale carbon dioxide and other unwanted substances with this interaction.

Similar to the digestive system we allow our body to have direct, not like e.g. with our hands that are protected by a sealed skin, contact with the environment while breathing. For such interaction we need to be prepared to gain the most and to protect at the same time our body . Therefore we have a special organ that serves as the lock for breathing: the nose.

Breathing through the mouth is as unnatural as eating through the nose.

While air passes our nose we get not only information about the volume, the speed, the temperature and the humidity of the air, but also about the content. Are toxic gases in the air, allergens, odors, insects and particles? And our nose has the ability to react to this information with swelling or shrinking, from our sinuses additional air can be mixed into the inhaled air thus adjust temperature and humidity.

When the lining of our nasal passage is inflamed it may not only expand, but also become red and produce waterish secretion.

The redness and inflammation may reach a level where the lining, which is called mucosa, lacks protection and occasionally begins to bleed.

Nose bleeding is often related to inflammation of the nasal lining, especially when the inflammation is expressed as a result of infection.

Inflammation of the nose also leads to swelling at least when we are lying down. Therefore inflamed nasal mucosa goes ahead with nasal congestion at least in the night. But it makes us also very sensitive to air-conditioned temperature, perfumes, and dust particles. We tend to sneeze when we are exposed to such air characteristics.

There are four major reasons why we develop inflammation anywhere in our body.

  • It can be any mechanical or physical reason, such as mechanical strain from a physical activity  a burn or freeze or  or any impact of environmental influences like rubbing clothes or wind that blows in the eyes, etc. ..For the nose this could be the high speed of airflow when a structural bottleneck situation is present or the picking finger. A common physical cause for inflammation in children is the presence of a foreign body (small toy particles) or candies and nuts
  • It may also be a chemical reason. For example acid or reactive chemical substances may cause an inflammation when they have contact with our body. For the nose this could be formaldehyde in cigarette smoke, but also drugs  and nose sprays,  petrol or any gas.
  • It may as well be a biological reason . Here we differentiate between allergic reason, where a potentially harmless substance ignites a reaction of our body that leads to inflammation, and infectious reason where germs enter our body and ignite an inflammation. For the nose allergies are almost always due to contact with fine particles that are hovering in the air and then inhaled. Infection is in the majority a result of contamination with viruses, but also bacteria and  in some places of the world molds or fungus may be responsible for a few cases of such inflammation. The interesting point here is that often the center of infection sits in the sinuses and not directly in the nasal cavity
  • In this list we may ignore the presence of inflammation from radiation and tumor toxins, because such inflammation

It is the task of the otolaryngologist to identify the cause for congestion and the reason for a swelling.

I use in my practice the nasal endoscope and the flexible naso-pharyngoscope to get a picture of the situation in the entire nasal passage. Additionally Ultrasound of the sinuses will give a hint if the reason is situated in the sinuses.

I also perform allergy prick tests to search for allergic causes. It depends on the findings of these investigations if a CT, a computer tomography or an MRI, a magnet resonance imaging needs to be conducted.

Such imaging investigations are usually performed to aide the further planning of treatments, also rhinomanomtry is an important tool to get a clear idea about the situation and the necessary treatment..

The Ct scan is an x-ray that shows me the bony nose and sinus structures in three dimensions and displays the extent of soft tissue swelling in the sinuses and nose as well as the structural changes of the nasal septum and structures like  hollow  turbinates or hypertrophic turbinates.. It reveals nicely situations after prior surgeries and gives hints about the dignity of swellings.

An MRI is rather interesting if we look for tumor structures or if radiation needs to be avoided, e.g. pregnancy or childhood.

If patients suffer congestion of the nose for a longer time, it is very likely that they have developed additional pharyngitis and snoring. They may even have already sleep apnea. Gastric reflux and heartburn may occur with the effect of chronic laryngitis, cough and asthmatic nocturnal arousals along with sweating, tachycardia and anxiety. In such cases a sleep study may help to evaluate the situation. Also a flexible laryngoscopy will bring light into the status of the larynx and the severity of reflux.

People who suffer nasal congestion have particularly problems when they go diving or when they are flying by plane. The congestion of their nose may not only extend to a congestion of the sinuses, but also to the middle ears. And when ambient pressure changes the entrapped air in these cavities may expand or shrink and create either a painful pressure or a painful vacuum. I have had numerous  divers, frequent flyers , pilots and cabin crew amongst my patients, because of this effect.

While the nose is as demonstrated above the organ for breathing it is in its apex under the scull base closely connected to the olfactory portion of the brain. And the nose contains an organ for the detection of pheromones. The proximity to the brain indicates us the enormous importance of the nasal function. And this can become an issue during our sleep.

When we sleep we undergo various sleep levels out of which the slow wave sleep levels are extremely important for the refreshment of our cells. It happens however that such slow wave sleep is very deep sleep and like in a coma requires only basic body functions to be under control. such as the nasal breathing.

I explained previously that we cant have such control with mouth breathing. Therefore slow wave sleep requires nose breathing.

What if the nose is congested. In that situation we keep on struggling to get air through the nose with the effect of snoring, but also with the effect of sleep apnea and gastric reflux. Eventually however we give up and sleep on lighter levels with the opened mouth. The impact on our heath is tremendous, because the typical slow wave sleep tasks will not be performed to the same extend.

These tasks are mainly related to the production of growth factor and the intracellular work that is related to those factors and results in recharging cells with necessary proteins which will be used during the day. A lack of such protein production leads to a general lack of body restoration, body immunity , growth  and brain restoration.

The result is a faster aging and frequent sickness with reduced performance and in children additional signs of imbalanced behavior like ADD, frequent sickness and lack of growth.

It is amazing to understand the full importance of a clear nose in the light of such effects.