Prairie Doc Perspective Week of July 30th, 2023
By Donald Bennett, MD
One of the most common reasons a person comes to the Ear Nose and Throat clinic is a stuffy nose. The way the symptoms are described varies. The stuffiness or congestion can be present at all times, at certain times of year, worse on one side, alternate sides, and may or may not respond to medications.
Getting this clear history and taking a close look helps me determine what are the causes and how best to help.
The nasal passages are divided from left and right by the nasal septum, which is made of bone and cartilage. A deviation (or bend) of the septum is common, but can be more extreme in some cases and cause significant narrowing of the nasal passage on one or both sides. Some are born with this deviation, and it may worsen as the person grows. Sometimes a history of a nasal injury is present, which could have bent the septum or increased the chance it becomes more bent over time if the injury occurred in childhood.
Within the nasal cavity are outpouchings called turbinates. A job of the nose is to prepare the air for the lungs, and it has structures that allow the air to be humidified, warmed and filtered. The turbinates are covered with a lining, called mucosa, which has numerous mucous glands and microscopic hairs. The turbinates are rich with blood vessels and periodically swell. This normal cycle of swelling can cause nasal congestion that alternates sides every few hours if the turbinates are excessively swollen.
The turbinates can become excessively swollen for several reasons, including viral infections, irritation from dryness, or allergies to name a few. Turbinate swelling can respond to topical medications such as steroid and antihistamine spray. Medical management of allergies if present, including allergy shots, can improve and control symptoms over time.
A less frequent cause of nasal congestion includes nasal polyps. These can be difficult to see from the front of the nose unless they are extremely enlarged. As an ENT, we often use a scope to see if these are present. A CT scan can also help.
An even less frequent cause of congestion includes weakness of the cartilage of your nose. This can happen over time, or can be seen after an injury or prior surgery. A careful exam in the clinic can help determine if this problem is present. It is often managed with surgery.
In most cases there is more than one cause of a person’s nasal congestion. If medicines do not improve symptoms, surgery can improve nasal breathing. A discussion with your surgeon on the risks and benefits to make an informed decision may be the next step.
Dr. Bennett has been trained to provide comprehensive otolaryngology care. Dr. Bennett practices at Midwest ENT & Allergy in Sioux Falls, SD. His special interests include disorders of the ear/hearing, endoscopic sinus surgery, pediatric otolaryngology, head and neck surgery, thyroid and parathyroid disorders, voice and swallowing disorders. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc®, a medical Q&A show providing health information based on science, built on trust, streaming live on Facebook most Thursdays at 7 p.m. central.