Nasal Congestion: Causes, Treatments, and Solutions

Nasal allergy issues?

Hello Doctor, I have been troubled by nasal congestion for over ten years.
I don't have much nasal discharge or frequent sneezing, but the congestion is unbearable.
During the day, aside from when I have a cold, my nose is generally clear, though sometimes it feels stuffy.
However, when I take a hot shower, my left nostril becomes very clear, allowing me to easily clear out debris, while my right nostril becomes completely blocked, making it difficult to breathe in and out.
Recently, I've noticed that if I rinse off with cool water after a hot shower, the congestion in my right nostril eases a bit, but when I use a hairdryer on a hot setting, my right nostril gradually becomes blocked again.
When I lie down to sleep, my nose, which was somewhat clear, becomes congested on both sides, feeling as if I have nasal discharge, but I can't seem to expel it.
I've seen many ENT specialists who say it's nasal allergies.
Currently, I take antihistamines at night and use a nasal spray, which involves shaking the bottle, leaning forward, and spraying into my nose.
However, I often find that after spraying, my nose feels even more congested, and sometimes it starts to block up even while standing.
In the morning, I usually wake up with nasal congestion that only improves after being active for a while.
I have sleep apnea and currently use a CPAP machine, but the nasal congestion makes it difficult to wear the device, which is very frustrating.
I would like to ask a few questions:
1.
Am I suffering from nasal allergies?
2.
Why is my left nostril clear after a hot shower, but my right nostril is very blocked?
3.
Are there any methods to improve the nasal congestion I experience when lying down to sleep?
4.
I had a uvulopalatopharyngoplasty and tonsillectomy a few years ago to help with my airway, but since my weight has continued to increase, the benefits were only noticeable immediately after the surgery.
I now regret having the surgery; will not having a uvula and tonsils have a significant impact on me at 30 years old? I am hesitant to even look at my mouth.
I initially weighed 90 kg before the surgery, but I later gained weight to over 100 kg.
I am now slowly losing weight and returning to 90 kg.
If I continue to lose weight, will my mouth breathing become less obstructed?
5.
If there is a way to improve the nasal congestion when lying down, will my body adjust to breathing through my nose?
I apologize for the lengthy and numerous questions, but this has been troubling me for over a decade, and I hope to receive your advice.

Dan dan de you shang, 30~39 year old female. Ask Date: 2018/07/11

Dr. Zheng Jueyi reply Otolaryngology

Hello,
1.
Based on the symptoms, the primary issue is nasal congestion, with no significant sneezing or nasal discharge, which may not necessarily indicate allergic rhinitis.
A medical examination is required for proper diagnosis.

2.
It may be necessary to check for issues such as a deviated septum or hypertrophy of the inferior turbinates.

3.
It is recommended to continue medication or nasal sprays for control; if there is no significant improvement after three months, surgical treatment may be considered.

4.
Surgical removal of the uvula and tonsils will not have a significant impact on a 30-year-old adult.
The severity of obstructive sleep apnea is related to body weight, and continued weight loss is advised.

5.
Normal physiology involves breathing through the nose; long-term mouth breathing should be evaluated by a healthcare professional.

Wishing you health and safety,
Dr.
Jue-Yi Cheng,
Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2018/07/11

More Info

Nasal congestion can be a frustrating and debilitating condition, especially when it interferes with daily activities and sleep. Based on your description, it seems that you are experiencing chronic nasal congestion, which may be related to allergic rhinitis, structural issues in the nasal passages, or other underlying conditions. Let’s address your questions one by one.

1. Am I allergic?
Given your symptoms and the fact that you have been diagnosed with nasal allergies, it is likely that you are experiencing allergic rhinitis. This condition occurs when your immune system overreacts to allergens, leading to inflammation and swelling of the nasal passages. Common triggers include pollen, dust mites, pet dander, and mold. It is essential to identify your specific allergens through allergy testing, which can help tailor your treatment plan.

2. Why does my left nostril clear up while the right one remains blocked during a hot shower?
This phenomenon is known as the "nasal cycle," where one nostril becomes more congested while the other is more open, and this alternates throughout the day. The warm steam from a hot shower can cause blood vessels in the nasal passages to dilate, temporarily relieving congestion in one side. If your left nostril opens up, it may be due to the natural cycle or the effect of steam, while the right side remains blocked due to structural issues or inflammation.

3. How can I improve nighttime nasal congestion?
To alleviate nighttime nasal congestion, consider the following strategies:
- Elevate your head: Use extra pillows to keep your head elevated while sleeping. This can help reduce nasal congestion and improve airflow.

- Humidifier: Use a humidifier in your bedroom to keep the air moist, which can help soothe irritated nasal passages.

- Nasal saline irrigation: Regularly using a saline nasal spray or performing nasal irrigation with a neti pot can help clear mucus and allergens from your nasal passages.

- Avoid allergens: Ensure your sleeping environment is free from allergens, such as dust mites and pet dander. Regularly wash bedding and consider using hypoallergenic covers for pillows and mattresses.

4. Impact of having had a uvulopalatopharyngoplasty (UPPP) and tonsillectomy:
Having undergone UPPP and tonsillectomy can significantly impact your airway, especially if you are experiencing weight fluctuations. These surgeries are intended to reduce airway obstruction during sleep, but if you have gained weight, it can lead to increased pressure on the airway, potentially negating the benefits of the surgery. Maintaining a healthy weight can help improve your breathing and overall health. As you lose weight, you may find that your airway becomes less obstructed, allowing for better nasal breathing.

5. Will improving nasal congestion lead to better nasal breathing?
Yes, if you can successfully manage your nasal congestion, it is likely that your body will adapt to nasal breathing rather than mouth breathing. Nasal breathing is generally more beneficial as it helps filter, warm, and humidify the air you breathe. If you can keep your nasal passages clear, you may find it easier to breathe through your nose, especially during sleep.

In conclusion, it is crucial to consult with an ear, nose, and throat (ENT) specialist who can evaluate your condition comprehensively. They may recommend allergy testing, imaging studies, or even surgical options if structural issues are identified. Additionally, lifestyle modifications, such as weight management and allergen avoidance, can significantly improve your symptoms. Remember, addressing the root cause of your nasal congestion is key to finding effective relief.

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