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nasal congestion
Medical expert of the article
Last reviewed: 04.07.2025
Nasal congestion is a well-known symptom for anyone who has suffered from a viral upper respiratory infection. The causes of chronic nasal congestion are discussed below.
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Causes of nasal congestion
- In children: large adenoids; rhinitis; choanal atresia; tumors located in the posterior half of the nasal cavity (in the nasopharyngeal space), such as angiofibromas; foreign bodies.
- In adults: nasal septum defects, rhinitis, polyps, chronic sinusitis, granulomatous lesions (tuberculosis, syphilis, leprosy), iatrogenic effects (use of local vasoconstrictors, reserpine, tricyclic compounds).
Iatrogenic nasal obstruction (rhinitis medicamentosa)
Medicines (drops and sprays) that reduce congestion in the nasal mucosa by narrowing the blood vessels can damage the mucosa due to hypoxia. In this case, a "rebound phenomenon" often occurs, manifested by blood stagnation in the mucosa, which leads to even greater swelling, forcing the patient to increase the use of the drug. The nasal mucosa becomes edematous and red.
Please note: these decongestants should not be used for longer than 1 week.
Allergic rhinitis
It can be seasonal or year-round.
Symptoms: Sneezing, itchy nose, and rhinorrhea. The turbinates are swollen and the mucous membrane is pale or pinkish-purple. Nasal polyps are common. The allergen can be identified by skin testing.
Injectable courses of desensitizing drugs can help 70% of patients with seasonal allergic rhinitis, but only 50% of patients with house dust mite allergy. This treatment can also cause fatal anaphylaxis, so such patients need to be monitored for some time after each desensitizing injection, and cardiopulmonary resuscitation equipment should be available. Other therapeutic measures include the use of antihistamines [eg, terfenadine 60 mg every 12 hours orally], general decongestants [eg, pseudoephedrine 60 mg every 12 hours orally, side effects - hypertension, hyperthyroidism, exacerbation of coronary artery disease; concomitant use of MAO inhibitors is contraindicated); sprays (for example, 2% sodium cromoglycate solution, 2 “exhausts” of 2.6 mg every 4-6 hours) or nasal steroid therapy (for example, beclomethasone dipropionate, 8 inhalations of 50 mcg during the day).
Note: Steroid nasal inhalers can be used continuously, but steroid drops are easily absorbed and have a general effect on the body, so they can be used for no longer than 1 month per course of treatment, with no more than 6 courses of treatment per year.
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Vasomotor rhinitis
It also causes nasal obstruction and/or rhinorrhea. It is usually difficult to identify the allergen. Rhinoscopy shows swollen and edematous turbinates, and excessive mucus production.
Treatment: The usual measures taken for allergic rhinitis are ineffective. Rhinorrhea is relieved with ipratropium in the form of a nasal spray (2 inhalations of 20 mcg in each nostril every 6 hours). Nasal congestion can be relieved by cauterization or surgical reduction of the inferior turbinate.
Nasal polyps
Nasal polyps are commonly found in association with allergic rhinitis, chronic ethmoiditis and cystic fibrosis. Such patients may be given beclomethasone dipropionate aerosol, e.g. S "exhausts" per day (one "exhaust" = 50 mcg). Otherwise, polygectomy is necessary.
Deviated septum
It is rare in children, but affects up to 20% of adults. Deviation of the nasal septum may be secondary to a nasal injury. The deformity is corrected by surgical excision of a strip of bone and cartilage in the nasal septum, the so-called submucosal resection (SMR).
Diagnosis of nasal congestion
First of all, it is necessary to carefully collect anamnesis: how variable are the symptoms, the nature of the nasal obstruction, the effect of nasal congestion on eating, speech and sleep (snoring). When examining the patient, it is necessary to pay attention to any disorders of the nose, its curvature, whether both nostrils are completely closed (to do this, hold a nasal mirror under each nostril in turn and observe the fogging of the mirror); with the help of a mirror, examine the nasopharyngeal space (in children, it is better visualized on a lateral X-ray).