Nasal congestion

Nasal congestion is a well-known symptom for all who have suffered from a viral infection of the upper respiratory tract. The reasons for chronic nasal congestion are discussed below.

[1],

Causes of nasal congestion

• In children: adenoids of large size; rhinitis; atresia of the hoan; tumors localized in the posterior half of the nasal cavity (in the nasopharyngeal space), for example, angiofibromas; foreign bodies.
• In adults: nasal septal defects, rhinitis, polyps, chronic sinusitis, granulomatous lesions (tuberculosis, syphilis, leprosy), iatrogenic effects (use of local vasoconstrictor drugs, reserpine, tricyclic compounds).

[2], [3], [4]

Iatrogenic nasal obstruction (drug rhinitis)

Drugs (drops and spray), which reduce stagnation in the nasal mucosa due to the narrowing of the vessels, can lead to damage to the mucosa due to hypoxia. In this case, often there is a "ricochet phenomenon", manifested by stagnation of blood in the mucous membrane, which leads to an even greater edema that causes the patient to intensify the use of the drug. The mucous membrane of the nose becomes swollen and red.

Note: these decongestants can not be used for more than 1 week.

Allergic rhinitis

It can be seasonal or last all year round.

Symptoms: sneezing, a sensation of itching in the nose and rhinorrhea. Nasal conchae are edematous, and the mucous membrane is pale or pinkish-lilac. Often there are polyps of the nose. Allergen can be identified by skin tests.

Treatment courses for injections of desensitizing drugs can help 70% of patients with seasonal allergic rhinitis, and only 50% of patients suffering from allergies to house dust mites. This treatment can cause fatal anaphylaxis, so these patients need medical supervision for some time after each desensitizing injection, and at hand should be all that is necessary for cardiopulmonary resuscitation. Other therapeutic measures include the use of antihistamines (for example, terfenadine 60 mg every 12 hours), common decongestants [eg pseudoephedrine (Pseudoephedrin) 60 mg every 12 hours inside, side effects - hypertension, hyperthyroidism, exacerbation of IHD; contraindicated simultaneous use of MAO inhibitors); Sprays (eg, 2% sodium chromoglycate solution , 2 "exhaust" at 2.6 mg every 4-6 hours) or nasal steroid therapy (for example, beclomethasone dipropionate, 8 inhalations of 50 micrograms per day).

Note: steroid nasal inhalers can be used constantly, but steroid drops are easily absorbed and have a general effect on the body, so that they can be used no longer than 1 month for 1 course of treatment, spending no more than 6 courses of treatment per year.

[5], [6], [7], [8], [9]

Vasomotor rhinitis

It also causes nasal obstruction and / or rhinorrhea. It is usually difficult to establish an allergen. With a rhinoscopy, swollen and swollen nasal conchae are visible, excessive production of mucus is noted.

Treatment: the usual measures taken with allergic rhinitis, are ineffective. Rhinorrhea is stopped by ipratropium in the form of nasal aerosol (2 inhalations of 20 mcg in each nostril every 6 h). Nasal congestion can be removed by cauterization or surgical reduction of the volume of the inferior nasal concha.

Nasal polyps

Nasal polyps are commonly found in association with allergic rhinitis, chronic ethmoiditis and cystic fibrosis. Such patients can recommend a beclomethasone dipropionate aerosol, for example S "exhaust" per day (one "exhaust" = 50 μg). Otherwise, a polygonctomy is required.

Curvature of nasal septum

In children, it is rare, and in adults affects up to 20% of the population. The curvature of the nasal septum may be secondary to the injury of the nose. Deformation is eliminated by surgical excision of the bone and cartilage stripe in the nasal septum, the so-called submucous resection (CMR).

[10], [11], [12], [13]

Diagnosis of nasal congestion

First of all, it is necessary to carefully collect anamnesis: how variable are the symptoms, the nature of the obstruction of the nostrils, the effect of nasal congestion on eating, speech and sleep (snoring). When examining the patient should pay attention to any violations from the nose, its curvature, whether both nostrils are completely closed (for this you should hold the nasal mirror alternately under each nostril and observe the fogging of the mirror); using a mirror to examine the nasopharyngeal space (in children it is better visualized on the lateral x-ray).

[14], [15], [16]