Nasal Congestion

Nasal congestion, commonly referred to as a blocked nose, is the inflammation of the mucosa lining the nasal cavities and the blood vessels supplying it. This swelling causes difficulty breathing due to partial obstruction of the nasal passages.

The duration of symptoms allows two main types of nasal congestion to be distinguished:

• Acute nasal congestion: resolves within approximately 7 to 10 days.
• Chronic nasal congestion: if it persists beyond 14 days, the underlying condition may be worsening. It is considered chronic when it lasts for more than 12 weeks.

When nasal congestion is persistent, it can negatively affect quality of life, as it interferes with nighttime rest, physical performance, and overall well-being. Prognosis depends on the underlying condition causing it; therefore, identifying the cause as early as possible is essential to determine the most appropriate treatment in each case.

Symptoms

Nasal congestion is usually accompanied by other symptoms, which vary depending on the underlying cause. The most common include:

• Rhinorrhea: nasal discharge ranging from clear, watery mucus to thick white, yellow, or green mucus.
• Difficulty breathing through the nose.
• Anosmia: loss of the sense of smell.
• Hyposmia: reduced sense of smell.
• Pain or a sensation of pressure around the eyes, forehead, and cheeks.
• Cough and sore throat caused by postnasal drip, which is mucus that accumulates or drains down the back of the throat.
• Sneezing.
• Nasal itching.
• Snoring.
• Sleep apnea: breathing temporarily stops during sleep.
• Rhinolalia: alteration of vocal resonance resulting in a nasal-sounding voice.

In some cases, particularly those related to structural causes, nasal congestion without mucus may occur, characterized by tissue inflammation in the absence of nasal secretions.

Causes

Nasal congestion may result from numerous causes, which can be classified into three main groups:

• Inflammatory causes:
  • Viral upper respiratory tract infections: these cause inflammation of the nasal mucosa:
• Common cold (rhinovirus infection).
• Influenza.
• COVID-19 (SARS-CoV-2).
  • Allergic rhinitis: also known as hay fever, it is an allergic response to pollen, dust mites, pet hair, and other environmental allergens.
  • Sinusitis: inflammation of the paranasal sinuses (air-filled cavities within the bones surrounding the nose), causing mucus production and obstruction.
  • Nasal polyps: benign growths that develop inside the nose or paranasal sinuses. They are characterized as soft and painless masses.
  • Hormonal changes: estrogen and progesterone increase blood flow and may consequently cause inflammation within the nose. For this reason, nasal congestion is common during pregnancy, menstruation, and menopause.
• Structural causes:
  • Deviated nasal septum: the bone and cartilage dividing the nose are displaced toward one side.
  • Inferior turbinate hypertrophy: abnormal enlargement of the structures responsible for filtering, warming, and humidifying inhaled air.
  • Adenoid hypertrophy: abnormal enlargement of the adenoids, also known as adenoid tissue, which is lymphatic tissue located at the back of the nasal cavity that helps fight infections.
• Behavioral causes:
  • Lying down to sleep: nighttime nasal congestion results from increased blood flow to the nose while in a recumbent position.
  • Active or passive smoking: tobacco smoke chronically irritates the internal nasal tissues.
  • Exposure to irritants, such as air pollution, strong cleaning products, or heavily scented perfumes.
  • Consumption of spicy foods: nerve endings are stimulated and blood vessels dilate.

Risk Factors

The risk of nasal congestion increases in the following situations:

• Sex: women are more prone due to hormonal changes associated with the menstrual and reproductive cycles.
• Allergies to dust mites, mold, pollen, animal hair, or dander.
• Asthma.
• Frequent respiratory infections.
• Exposure to pollutants, chemicals, or strong perfumes.
• Sudden temperature changes.
• Prolonged use of decongestant nasal sprays.

Complications

In most cases, nasal congestion does not lead to serious complications. However, if not appropriately treated or if it becomes chronic, it may result in:

• Chronic sinusitis: inflammation of the paranasal sinuses lasting more than 12 weeks.
• Otitis media: infection or inflammation of the middle ear (between the eardrum and the inner ear).
• Worsening asthma: the airways become more constricted than usual.
• Sleep disturbances: reduced nasal airflow may cause sleep fragmentation, mouth breathing, snoring, and worsening of sleep apnea in affected patients.
• Reduced quality of life: breathing difficulties negatively affect rest and daily performance. In addition, they may cause persistent fatigue, poor concentration, and frequently social discomfort.
• Pharyngitis and laryngitis: breathing through the mouth allows cold, dry, unfiltered air to reach the throat, causing irritation, dryness, throat clearing, and pain.

Which specialist treats nasal congestion?

Nasal congestion is commonly managed within the specialties of Family and community medicine or Pediatrics. When symptoms persist, specialists in Otorhinolaryngology or Allergology become involved.