Congestion & Stuffy Nose

A congested, stuffy nose is a nuisance that can affect your ability to smell, taste and breathe. It is one of the most common patient complaints during an ENT appointment, especially when it persists with nasal discharge.

What Causes Nasal Congestion?

Congestion, or nasal obstruction, occurs when airflow through the nose is restricted; this can be due to changes in anatomy or swelling and inflammation of nasal tissues and blood vessels. It has little to do with excess mucus, which many people believe.

Anything that irritates the nasal tissues can cause congestion. The list of possible causes is lengthy and includes infections (colds, influenza and acute or chronic sinusitis ), allergies, structural abnormalities (deviated septum, enlarged adenoids/tonsils, nasal polyps or tumors), non-allergic rhinitis, dry air, cold temperatures, bright lights, cluster headaches, hormonal changes, medications, thyroid problems, spicy foods, tobacco smoke and stress.

Treating Congestion

Decongestants: For occasional congestion, decongestants are a good short-term choice. They constrict blood vessels, decreasing blood flow to the nose’s lining and diminishing that lining thickness; this leaves more room for air flow. Decongestants come in pill form and topical sprays. They are effective but may come with some side effects. Decongestants commonly cause a rapid heart rate and can raise blood pressure. If you have a history of coronary heart disease or heart attack, you should avoid them. They can also give you the jitters and make it difficult to sleep.

Also, topical decongestant sprays are notorious for being habit-forming. For that reason, doctors recommend that you use these sprays for only a few days at a time. Some people who use decongestant sprays can become dependent on them and may find that they can’t breathe well through their nose without them.

Antihistamines: Antihistamines can reduce swelling and mucus production. They are most effective when your congestion is due to allergies. Well-known antihistamines are Benadryl (diphenhydramine), Zyrtec (cetitirizine), Allegra (fexofenadine) and Claritin (loratidine). The last 3 in this list have the advantage of not having as many sedating side effects that Benadryl has.

Topical Nasal Steroids: These can be very effective, especially with allergies. They have a general local anti-inflammatory effect, but the exact way they work is not entirely understood. Commonly used nasal steroids include Flonase (fluticasone) and Nasonex (mometasone). These meds can have a drying effect, and if you are prone to nose bleeds, you might want to choose other options to treat your nasal congestion.

Anti-Leukotrienes: These meds were first used for asthma and later for allergic nasal congestion since they help with allergies. If polyps are part of the cause of your congestion, then this class of medications may be beneficial. The best-known anti-leukotriene is Singulair (montelukast).

Nasal Saline: Saline can come as a spray (in a bottle) or as irrigation (basically saltwater used to flush out the nose). Some people even make homemade saline irrigation recipes.