Chronic Nasal Congestion: Is Surgery the Solution? - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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Mr.
No more nasal congestion troubles.
Here is an article for your reference.
┌─── 　■ Yeh Da-Wei ENT Clinic Medical Education ■　 ─── 2000/02/20 ┐
The leading dizziness specialist in the Zhuliang-Miaoli area, a pioneer in online medicine in Taiwan.
└─　Yeh Da-Wei ENT Clinic website: http://www.csie.nctu.edu.tw/~yehdawei ─┘
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【The 'Nasal Disease Package Cure' that Makes One's Nose Tingle】
In the outpatient clinic of an ENT specialist, symptoms such as cough, headache, dizziness, and nasal congestion are extremely common.
However, due to the complex causes of these symptoms, treatment can be challenging, leading patients to flock to exaggerated advertisements claiming "cure" and "complete treatment." In the past two years, I have treated many patients after undergoing the so-called "five-minute nasal disease cure," resulting in issues such as nasal mucosa adhesion, nasal vestibule inflammation, nasal passage narrowing, and nasal septum perforation—truly a distressing situation.
The causes of nasal congestion generally include "infection," "nasal structural abnormalities," "allergic rhinitis," and "vasomotor rhinitis," each with its pathogenic mechanisms and treatment approaches.
Of course, each condition has its limits in efficacy, which has allowed these alternative practitioners to thrive.
Below, I will briefly introduce 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, presenting not only with nasal congestion but also with post-nasal drip, headache, difficulty concentrating, and chronic nighttime cough.
In children, this can significantly impact sleep quality and academic performance.
If conservative treatments such as medication and nasal irrigation are ineffective, surgery may be recommended.
The previously common Luc's radical surgery, which involved incising the lip to remove the entire sinus mucosa, has now been completely replaced by endoscopic sinus surgery.
Endoscopic surgery allows for selective removal of obstructive mucosal tissue under good visualization, restoring normal sinus function.
◎ Nasal Structural Abnormalities: Deviated septum, chronic hypertrophic rhinitis.
A "deviated septum" can be caused by natural compression at birth or trauma leading to cartilage bending.
The degree of deviation does not always correlate with nasal congestion, and the decision to surgically correct it can depend on the patient's subjective experience.
"Chronic hypertrophic rhinitis" refers to the hypertrophy of normal turbinate tissue, which can cause nasal congestion symptoms.
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 may be misinformed that these are nasal polyps and undergo inappropriate cauterization.
◎ 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 nasal 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 cause 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 nasal congestion symptoms.
Treatment options for chronic hypertrophic rhinitis, allergic rhinitis, or vasomotor rhinitis include conservative oral medications, nasal sprays, traditional inferior turbinate reduction surgery, and advanced laser surgery.
There are also newer techniques using thermal probes placed submucosally in the turbinates, where radiofrequency generates low heat to cause protein coagulation in the submucosal tissue, leading to fibrosis and reduction of the hypertrophied turbinate tissue.
Nasal congestion may not be classified as a disease, but it is certainly a bothersome symptom.
It not only makes breathing difficult but can also lead to dizziness, headaches, difficulty concentrating, snoring, insomnia, or sleep apnea.
Consulting a professional ENT specialist to identify the true cause of nasal congestion and selecting appropriate symptomatic treatment is the right approach.
I sincerely hope to no longer see so-called "cure-all nasal disease packages" in the clinic.

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Reply Date: 2006/03/23