Stuffy Nose

Nasal congestion (stuffy noses) may be caused by swollen or congested nasal tissues or a structural abnormality.

Swollen nasal tissues may be caused by:

Infection (viral or bacterial) – common cold, flu, sinus infection
Allergies or hayfever
Overuse of certain nasal sprays or drops (decongestants such as Afrin, neosynephrine)
Vasomotor rhinitis (see below)
Hormones (during pregnancy, underactive thyroid gland)

Structural abnormalities include:

Deviated septum (deformed middle divider of the nose)
Nasal deformity from trauma (nasal fracture)
Enlarged adenoids (primarily in children)
Nasal growths such as polyps, tumors
Foreign bodies (primarily in children)

What is vasomotor rhinitis?

It causes swelling of the nasal tissues and may be triggered by many non-specific stimuli. It is a non-infectious, non-allergic, chronic condition. It is associated with changes in the control of the vessels and nerves in the lining of the nose that leads to the development of chronic nasal congestion. Emotional stimuli, rapid changes in body temperature, changes in humidity, and hormone changes such as pregnancy, menstruation or menopause may cause symptoms of this non-allergic condition. The symptoms may be worse upon awakening in the morning, or with exposure to drafts, chemical fumes or tobacco smoke and with certain medications.

How is nasal congestion treated:

Home care

Nasal saline sprays and rinses (Ocean, Neil-Med, Ayr, etc.) may thin mucus.
Increase the humidity in the air with a vaporizer or humidifier.
Drink extra fluids.
Elevate the head of the bed at night.
Decongestants (Sudafed) shrink the blood vessels in the lining of the nose.
Decongestants nasal sprays (Afrin, neo-synephrine) also shrink the blood vessels in the lining of the nose but should not be used more than 3 days.
Antihistamines help with allergy symptoms of sneezing, itching and nasal mucus. Certain antihistamines may make you drowsy.
Babies may be treated with nasal saline drops and an infant nasal bulb or aspirator.
Adhesive nasal strips (Breath-rite) may be placed on the nose to widen the nostrils and may make breathing easier.

When to contact a doctor:

If there is persistent yellow-green, bloody, gray or foul smelling mucus.
If there is swelling of the forehead, eyes, side of the nose, or cheek.
If there is blurred vision.
Coughing episodes that last longer than 10 days.
Nasal congestion that lasts longer than 2 weeks and significantly interferes with your life.
If there has been recent trauma to the nose causing a change in appearance.

What to expect at the doctor’s office:

A history will be taken and a physical examination will be performed.
Your nose will be examined using a nasal speculum and possibly with a nasal endoscope.
Cultures of the drainage from your nose may be taken.
X-rays or a CAT Scan may be ordered.
Allergy skin tests may be performed.

Prescription medications may be recommended:

Intranasal steroids (Flonase, Nasonex, Rhinocort, etc) – reduce inflammation in the
nose.
Antihistmines (Allegra, Xyzal, Astepro, Pantanase).
Oral steroids reduce inflammation (please see precautions below).
Leukotrience inhibitory (Singulair) is used for treating allergies.
Antibiotics are used for bacterial infections.

Surgery may be recommended for structural problems such as a deviated septum or nasal polyps and for chronic sinus infections or chronically swollen membranes that don’t improve with medications.

Important Information Regarding

THE USE OF SYSTEMIC (BY MOUTH OR INJECTION) CORTICOSTEROIDS

(e.g. Prednisone, Medrol, Decadron, Cortisone, Kenalog)

Corticosteroids are commonly used medications to treat many diseases including sinusitis, nasal polyps, allergies and asthma. They are potent drugs and affect many organ systems. They are essential to the care of millions of patients, enabling them to live normal lives. These are not anabolic steroids, which are abused by some athletes.

The doses of these drugs are individualized. For most patients, they are needed for a week or so, however in some, they are needed for prolonged periods. When they are used, they will be used cautiously and properly to minimize the potential for side effects.

The amount of absorption varies by route of administration. Topical preparations (e.g. nasal and oral inhalers) have a lower potential for side effects compared to oral or injectable forms. In fact, use of nasal and/or oral inhalers can decrease the patient’s need for oral and injectable steroids.

Side effects of steroids usually occur only after prolonged uses and/or high doses. Notify your doctor of any other medications, including over the counter drugs, you are currently taking to avoid unfavorable reactions.

PRECAUTIONS: If you have glaucoma, cataracts, peptic ulcers, osteoporosis, diverticulitis, diabetes, tuberculosis, or if you have ever had serious mental problems, or are already taking another steroid drug, pregnant or think you might be pregnant, notify the doctor before you start your steroid medications. If you develop a serious infection, injury or need surgery while on steroids, please notify your doctor immediately. Your dosage of steroids may need to be changed.

POSSIBLE SIDE EFFECTS: (Permanent problems are rare but possible) Side effects which may occur in some patients include nervousness, insomnia, mood swings; weight gain secondary to fluid retention and increased appetite; muscle weakness; softening of the bones that may lead to fractures (especially of the back and hips); easy bruising; poor wound healing and thinning of the skin; menstrual irregularities; impaired growth in children; exacerbation of stomach ulcers and diabetes mellitus; blood circulation problems (especially in the hip – e.g. avascular necrosis which could result in the need for surgical treatment and joint replacement); cataracts; possible exacerbation of pre-existing or impending glaucoma; and psychological disturbances such as euphoria, irritability, depression or hallucinations.

Occasionally stopping steroids after taking them for several weeks or longer may cause symptoms of lethargy, fatigability, weakness, depression and various aches and pains, particularly in joints and muscles. These symptoms usually resolve over a period of several days to weeks, nonetheless, notify the doctor as soon as possible.

While taking these medications consider including the following via diet and/or as a supplement:

Calcium 1200mg daily and Vitamin D 800 IU daily as well.
To protect your stomach against upset/ulcers: OTC Prilosec daily or 1 oz of an antacid (Maalox/Mylanta).