Chronic Nasal Congestion: Causes and Solutions - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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Sometimes it is like this.
If medication continues to be ineffective and nasal congestion persists, surgical intervention should be considered.

In the clinic of Dr.
Da-Wei Yeh, an ENT specialist, common symptoms such as cough, headache, dizziness, and nasal congestion are frequently encountered.
However, due to the complex causes of these symptoms, treatment can be challenging.
Patients often flock to exaggerated claims of "cure" and "guaranteed treatment" from alternative practitioners.
In recent years, many patients have come to the clinic after undergoing the so-called "five-minute nasal disease cure," resulting in complications such as nasal mucosal adhesions, vestibular inflammation, nasal cavity narrowing, and septal perforation, which are truly distressing.
The causes of nasal congestion generally include "infection," "structural abnormalities of the nose," "allergic rhinitis," and "vasomotor rhinitis," each with its own pathogenic mechanisms and treatment approaches.
Of course, each condition has its limits in terms of treatment efficacy, which has allowed alternative therapies to gain traction.
Below is a brief introduction to each condition based on this classification.
◎ Infection: The most common cause of nasal congestion is the common cold.
Once the cold resolves, the congestion typically subsides.
Bacterial infections leading to sinusitis are more severe and can include symptoms such as post-nasal drip, headache, difficulty concentrating, and chronic nighttime cough.
In children, this can significantly affect sleep quality and academic performance.
If conservative treatments such as medication and nasal irrigation are ineffective, surgery may be recommended.
Previously, the most common surgical procedure was the Luc operation, which involved incising the lip to remove the entire sinus mucosa.
This has now been completely replaced by endoscopic sinus surgery, which allows for selective removal of obstructive mucosal tissue under good visualization, restoring normal sinus function.
◎ Structural Abnormalities of the Nose: Deviated septum and chronic hypertrophic rhinitis.
A deviated septum can occur naturally at birth or as a result of trauma causing cartilage distortion.
The degree of deviation does not always correlate with nasal congestion, and the decision to correct it surgically can depend on the patient's subjective experience.
Chronic hypertrophic rhinitis refers to the thickening of normal turbinate tissue, which can cause nasal congestion.
The turbinates, also known as nasal conchae, are normal physiological structures located on the lateral wall of the nasal cavity, and patients can often see them when examining their own nasal cavities.
Sometimes, patients are misinformed that these are nasal polyps and subjected to inappropriate cauterization procedures.
◎ Allergic Rhinitis: Currently, there is no definitive cure for allergic rhinitis in medicine.
It is a disease caused by a specific predisposition, leading to edema of the nasal mucosa and resulting in congestion.
Treatment can be tailored based on the severity of symptoms, utilizing oral medications, nasal sprays, immunotherapy, or surgery to alleviate nasal congestion.
◎ Vasomotor Rhinitis: Various factors can lead to vasomotor rhinitis, including work stress, hormonal changes during pregnancy, certain antihypertensive medications, and even irritants such as perfumes, temperature and humidity changes, or cooking fumes.
These factors can cause dilation and congestion of the blood vessels in the nasal mucosa, leading to symptoms of nasal congestion.
Treatment options for chronic hypertrophic rhinitis, allergic rhinitis, or vasomotor rhinitis may include conservative oral medications, nasal sprays, traditional inferior turbinate resection, and advanced laser surgery.
There are also newer techniques involving the use of thermal probes placed submucosally in the turbinates, utilizing radiofrequency to generate low heat, causing protein coagulation in the submucosal tissue, leading to fibrosis and reduction of the hypertrophied turbinates.
Nasal congestion itself is not classified as a disease, but it is a highly bothersome symptom.
It can lead to difficulties in breathing, dizziness, headaches, lack of concentration, snoring, insomnia, or even sleep apnea.
Consulting a professional ENT specialist to identify the true cause of nasal congestion and selecting appropriate symptomatic treatment is the right approach.
It is sincerely hoped that we will no longer encounter claims of guaranteed cures for nasal diseases in the clinic.

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Reply Date: 2000/11/15