A stuffy nose | The causes and the treatment

By: Dr Andre van Straten
ENT Specialist. MBChB (Pret); FCORL(SA) ; MMED (Stell)

The causes and the treatment

Nasal congestion, or a stuffy nose, is the uncomfortable feeling of not being able to breathe adequately through your nose. This is common during colds or flu but fortunately temporary, and usually resolves with the other symptoms of your cold/flu. There are however some cases where the nasal congestion is chronic and may impair your quality of life.

What are the common causes of chronic nasal congestion?

  • Hay fever or allergies – Mostly due to airborne allergens such as pollen or grass seeds or house dust mite. Some allergies may be seasonal, while others will be present on most days of the week year-round.
  • Non-allergic rhinitis – This includes, amongst other things, a reaction to chemicals, perfumes, or insecticides.
  • Rebound rhinitis (Rhinitis medicamentosa) – Chronic nasal congestion caused by the overuse of nasal decongestants containing oxymetazoline. These are your typical nasal sprays used during colds or flu for temporary relief of nasal congestion. Remember – oxymetazoline-containing drugs should never be used longer than 5 days at a time.
  • Enlarged adenoids in children – Typically children with large adenoids will snore and sleep with an open mouth. Large adenoids may completely obstruct a child’s nose, forcing them to breathe through his/her mouth constantly.
  • Enlarged nasal turbinates – These are normal intra-nasal structures that help to humidify and warm air that flows through your nose. In some cases, these turbinates may become enlarged, thus limiting the space in your nose for air to pass.

Chronic sinusitis – This is a chronic inflammatory condition of the lining of your nose and sinuses. Nasal obstruction will be accompanied by one or more of the following: Thick discolored nasal discharged and, or post-nasal drip; a decreased sense of smell and taste; a feeling of fullness, pain, pressure, or tenderness around the eyes, nose, cheeks, and forehead; pain in your upper teeth.

  • Nasal polyps – These are non-cancerous teardrop-shaped growths originating from the lining of the sinuses. This is usually part of a specific type of chronic sinusitis. Polyps are painless and when large enough cause nasal obstruction and a reduced ability to smell.
  • A deviated septum – The wall between the nasal passages (nasal septum) may be displaced to one side. This usually causes constant nasal obstruction of one or both nostrils. People may be born with a deviated septum, or it may have developed following trauma to the nose.

How to treat nasal congestion:

When due to a cold and flu, the nasal congestion will improve with the rest of the symptoms, and there is no need for concern. For chronic obstruction, most of the causes can be effectively managed with the daily use of an intra-nasal steroid spray. The newer steroid sprays have been proven safe for chronic use, even in toddlers as there is close to zero systemic absorption of the steroid. With rebound rhinitis, the decongestant oxymetazoline spray should be stopped completely. This may be extremely difficult initially. You will also require at least an intra-nasal steroid spray.

When medical treatment fails to give the desired result, surgery may be indicated. This may include ESS (endoscopic sinus surgery), nasal turbinate surgery (turbinoplasty), and/or surgery to correct the deviated septum (septoplasty). In the case of children where enlarged adenoids have been diagnosed, an adenoidectomy where the adenoids are removed usually corrects the problem.

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