Nasal congestion, stuffiness, or obstruction to nasal breathing is one of men’s oldest and most common complaints. While it may be a mere nuisance to some people, to others, it is a source of considerable discomfort, and it inhibits their quality of life. 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.


What is Vasomotor Rhinitis?

“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. When a person exercises vigorously, their hormones of stimulation increase (or adrenaline). 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, the blood vessels lose their capability to constrict. They become similar to 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 by placing a brick or two under each castor of the bedposts at the head of the bed.

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Surgical Options

Surgery may offer dramatic and long-time relief. Sinuses are air-filled cavities in the skull. They drain into the nose through small openings. Blockages in the openings from swelling due to colds, flu, or allergies may lead to acute sinus infection. A viral “cold” that persists for more than 10 days may have developed into a bacterial sinus infection. With this infection, you may notice increase post-nasal drip.

If you suspect that you have a sinus infection, you should visit your ENT specialists for antibiotic treatment. Chronic sinusitis occurs when sinus blockages persist and the lining of the sinuses swell further. Polyps (growths in the nose) may develop with chronic sinusitis. Patients with polyps tend to have irritating, persistent post-nasal drip. Evaluation by an otolaryngologist may include an exam of the interior of the nose with a fiberoptic scope and CAT scan. If medication does not relieve the problem, surgery may be recommended.

Allergic & Other Conditions

Allergic nasal symptoms include sneezing and runny/itchy nose, caused by irritation and congestion in the nose. There are similar symptoms that arise in the absence of demonstrated allergies; this is called chronic rhinitis rather than allergic rhinitis.

What is Allergic Rhinitis?

This condition occurs when the body’s immune system over-responds to specific, non-infectious particles such as plant pollens, molds, dust mites, animal hair, industrial chemicals (including tobacco smoke), foods, medicines, and insect venom. During an allergic attack, antibodies, primarily immunoglobin E (IgE), attach to mast cells (cells that release histamine) in the lungs, skin, and mucous membranes. Once IgE connects with the mast cells, a number of chemicals are released. One of the chemicals, histamines, opens the blood vessels and causes skin redness and swollen membranes. When this occurs in the nose, sneezing and congestion are the results.

Seasonal allergic rhinitis or hay fever occurs in late summer or spring. Hypersensitivity to ragweed, not hay, is the primary cause of seasonal allergic rhinitis in 75 percent of all Americans who suffer from this seasonal disorder. People with sensitivity to tree pollen have symptoms in late March or early April; an allergic reaction to mold spores occurs in October and November as a consequence of falling leaves. Perennial allergic rhinitis occurs year-round and can result from sensitivity to pet hair, mold on wallpaper, houseplants, carpeting, and upholstery. Some studies suggest that air pollution such as automobile engine emissions can aggravate allergic rhinitis. Although bacteria is not the cause of allergic rhinitis, one medical study found a significant number of the bacteria Staphylococcus aureus in the nasal passages of patients with year-round allergic rhinitis, concluding that the allergic condition may lead to higher bacterial levels, thereby creating a condition that worsens the allergies.

Patients who suffer from recurring bouts of allergic rhinitis should observe their symptoms on a continuous basis. If facial pain or a greenish-yellow nasal discharge occurs, a qualified ear, nose, and throat specialist can provide appropriate sinusitis treatment.

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What is Non-Allergic Rhinitis?

This form of rhinitis does not depend on the presence of IgE and is not due to an allergic reaction. The symptoms can be triggered by cigarette smoke and other pollutants as well as strong odors, alcoholic beverages, and cold. Other causes may include blockages in the nose, a deviated septum, infections, and over-use of medications such as decongestants.

Surgery for Nasal Obstruction

Distorted anatomy in the nose is identified after appropriate medical measures have been exhausted. This may include oral antibiotics and/or steroids, and almost involves the trial use of anti-inflammatory sprays and washes. When these have been fairly attempted and obstruction persists, examination of the nose will often reveal a deviated septum and/or enlarged nasal turbinates. The turbinates are the primary air filtering structures in the nose and are responsible for maintaining inhaled air temperature, humidity, and cleanliness. While they are dynamic structures and can shrink and expand to allow for environmental and internal changes, the turbinates are not immune to misbehavior by adopting a chronically enlarged state.

Surgery for blockage and excess drainage may involve both the septum and the turbinates. Early nasal surgeons often completely removed the turbinates to accomplish nasal airway opening. Later, we realize that the turbinates are necessary structures and can best be treated when enlarged by shrinking them rather than eliminating them. This is accomplished either by partial removal of their interior bulk with typical surgical techniques such as cutting, removing tissue, and suturing the incision closed or by usage of newer technologies to shrink and eliminate tissue swelling from within the turbinate without incisions. Some of these procedures can be accomplished in the office without the need for general anesthesia, but also without the experience of pain.



Jeffrey L. Cutler, M.D.

Dr. Jeffrey Cutler is board-certified with the American Board of Otolaryngology and received his medical degree at Tulane University Medical School in New Orleans. He performed his residency at Vanderbilt University Medical Center in Nashville. In addition, he completed a 1 year fellowship in nasal and endoscopic sinus surgery.  His area of expertise includes the medical and surgical treatment of complicated sinus and skull base diseases.  Dr. Cutler has published many articles on office based nasal and sinus procedures - particularly on balloon sinus and Eustachian tube dilation  When not at the office, he enjoys spending time outdoors with his family, skiing and cycling.

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