Persistent Nasal Congestion and Associated Symptoms

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Hello, doctor.
I'm sorry to bother you again.
I used to have severe nasal allergies, but now I experience less runny nose and sneezing, although I do have nasal congestion that alternates between sides.
At night, one side is always completely blocked.
I have a deviated septum, but it's not severe.
I only experience complete nasal blockage when I have a cold or when the weather is cold, and I do not resort to mouth breathing.

Currently, I feel easily fatigued, often dizzy (not specific), have blurred vision (just want to close my eyes and rest), heavy eyelids, lack of focus, and poor memory.
I reported these issues to my doctor during my visits, but even with endoscopy or visual examination, there seem to be no apparent symptoms, as there are no obvious signs of nasal inflammation.
The nasal congestion and deviated septum do not obstruct my breathing, but the doctor noted that I appeared drowsy.

I have used nasal sprays to combat the congestion and taken oral antihistamines, but I wonder if my frequent use of nasal medications in my youth has rendered them ineffective.
I typically do not sneeze or have a runny nose, so there has been no change.
When I wake up, I feel okay (my sleep issues have been addressed, and I do not suffer from insomnia, and I get enough sleep), but after about half an hour, that feeling of fatigue returns.
It starts with eye fatigue, and my gaze becomes a bit unfocused, making it difficult to concentrate.
Then my nose feels slightly dry and itchy, and overall, there is a vague discomfort in the frontal and ethmoid sinus areas.

This condition is consistently linked with dizziness, and if it worsens, I experience mild headaches similar to my previous nasal allergies, but without the sneezing and runny nose.
If it intensifies further, it resembles the headaches and dizziness I experience during a cold.
The dizziness makes me want to close my eyes and rest, but I don't always feel fatigued.
It's hard to concentrate, and my gaze becomes unfocused.
If I don't rest, I easily become fatigued and my legs feel sore (as my job requires long periods of walking).
If I take another half-hour nap, I feel significantly better, but the symptoms return about an hour later.

This happens frequently on weekends, and at work, due to the noise and dust in the factory, I easily become distracted, make poor judgments, and have slow reactions, making it difficult to focus and think.
Therefore, I would like to ask the doctor: 1.
Are these symptoms caused by allergies? However, continuous medication has not improved the situation.
2.
During my visits, since there are no obvious abnormalities in the visible parts of my nose, how should I ask the doctor to further investigate other areas or conditions? (The discomfort is in the frontal and ethmoid sinus areas, extending to the eyes, eyebrows, and nasal bridge, with vague discomfort, but the most troubling symptoms are dizziness and blurred vision, etc.)

JS, 40~49 year old female. Ask Date: 2015/03/21

Dr. Zheng Jueyi reply Otolaryngology

Hello,
1.
If you are experiencing drowsiness or fatigue, it may be worthwhile to check if you are using long-acting antihistamines due to allergies.
If so, you can discuss with your physician the possibility of switching to a different formulation, as individual responses can vary, and some people may still experience drowsiness or difficulty concentrating.
2.
Additionally, aside from improving sleep, chronic stress accumulation may lead to tension-type headaches or migraines, which can present similar symptoms.
If there is no improvement, consider consulting a neurologist.
Wishing you health and safety,
Dr.
Cheng Jue-Yi,
Director of the ENT Department, Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2015/03/21

More Info

Persistent nasal congestion and associated symptoms can be quite challenging to manage, especially when they significantly impact daily life and overall well-being. Based on your description, it seems that you are experiencing a range of symptoms that may be interconnected, including nasal congestion, fatigue, dizziness, and cognitive difficulties. Let’s break down your concerns and explore potential underlying causes and next steps.

1. Allergic Rhinitis and Nasal Congestion: You mentioned a history of severe nasal allergies, which can evolve over time. While you may not be experiencing the classic symptoms of sneezing and runny nose as frequently, nasal congestion can persist. Allergic rhinitis can lead to chronic nasal congestion, which may not always present with overt inflammation or discharge. The fact that you experience alternating nasal congestion and a tendency for one side to be blocked at night suggests that there may still be an underlying allergic component or structural issues, such as a deviated septum, contributing to your symptoms.

2. Fatigue and Cognitive Issues: The fatigue, dizziness, and cognitive difficulties you describe could be related to several factors. Chronic nasal congestion can lead to poor sleep quality, even if you do not have overt sleep apnea. When nasal passages are obstructed, it can disrupt normal breathing patterns during sleep, leading to fragmented sleep and subsequent daytime fatigue. Additionally, the sensation of heaviness in the forehead and the feeling of needing to close your eyes could be indicative of sinus pressure or tension-type headaches, which can be exacerbated by nasal congestion.

3. Sinus Issues: The discomfort you feel in the frontal and ethmoid sinus areas (forehead and between the eyes) could suggest chronic sinusitis or sinus pressure. Even without clear signs of infection, chronic sinusitis can manifest with persistent nasal congestion, facial pressure, and headaches. It may be worthwhile to consider imaging studies, such as a CT scan of the sinuses, to evaluate for any anatomical issues or chronic inflammation that may not be visible during a physical examination.

4. Next Steps for Diagnosis: Given that your symptoms are not improving with over-the-counter medications, it would be prudent to discuss further diagnostic options with your healthcare provider. Here are some suggestions:
- Referral to an ENT Specialist: An ear, nose, and throat specialist can perform a more thorough evaluation, including nasal endoscopy, to assess the nasal passages and sinuses directly.

- Imaging Studies: If not already done, a CT scan of the sinuses can help identify any structural abnormalities, chronic sinusitis, or other issues that may be contributing to your symptoms.

- Allergy Testing: If you suspect allergies are still playing a role, consider discussing allergy testing to identify specific triggers that may be contributing to your nasal congestion.

- Sleep Study: If sleep quality remains a concern, a sleep study may help determine if there are underlying sleep disorders affecting your rest.

5. Management Strategies: In the meantime, consider implementing some self-care strategies:
- Saline Nasal Irrigation: Regularly using a saline nasal rinse can help clear mucus and allergens from the nasal passages.

- Humidification: Using a humidifier in your bedroom can help keep nasal passages moist, especially during dry seasons.

- Avoiding Irritants: Reducing exposure to known allergens and irritants (such as dust, smoke, and strong odors) can help minimize symptoms.

In conclusion, while your symptoms may have roots in allergic rhinitis, the persistence of nasal congestion and associated cognitive issues warrants further investigation. Collaborating closely with your healthcare provider and possibly seeking a specialist's opinion will be essential in identifying the underlying causes and developing an effective treatment plan. Your quality of life is paramount, and addressing these symptoms holistically can lead to significant improvements.

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