Why is my nose stuffy?

July 15, 2019July 29, 2019 healthyENT

Many people complain that they can’t breathe through their nose as well as they should. For some reason, one of the most basic bodily functions has become increasingly uncomfortable. Modern medicine has many solutions. These include medical and surgical options. Most people try a variety of medicines before considering surgery. The good news is, if you do need surgery, it can usually be done as an outpatient.

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What are the turbinates?

Before you shoot your gun, you need a target. In other words, we need to understand what we are dealing with if we want to fix the problem. The nose is simply two air passages in the center of the face with a wall in the middle. This wall is the septum. This is a common site of nosebleeds. The outer walls of these passages are curved, with three separate elevations per side. These elevations are called turbinates, and are thought to humidify and heat the air before it gets to the lungs. The sinuses are air pockets in the bones of the face. The sinuses open into the spaces between the turbinates. The outside of this complex three-dimensional structure is covered by a cap — the nose.

How turbinates works

The turbinates each take turns swelling and opening, so that one nasal passage is usually more open than the other. This is called the nasal cycle and occurs several times a day. If you are allergic to pollen, dust, cats, or any other allergen, this may cause swelling throughout the nasal lining, especially the turbinates. This swelling decreases the area of the nasal airway, and you feel this subjectively as stuffiness. You then become a mouth breather. For some people, this can occur as a result of changes in temperature and humidity. An infection of the nasal or sinus lining can also cause similar changes.

Trauma also accounts for difficulty breathing through the nose. A fracture of the septum can change it from a midline, flat wall into a bent, twisted shape. This will cause a change in the flow of air that you are used to and will cause a sensation of stuffiness that will last long after the initial swelling has resolved. Some people are simply born with a deviated (or curved) septum. This is very common and many people don’t know that they have this condition. The nose is sensitive to even the smallest blockage, and an obstructed flow of air will make you take notice. This blockage can also change you from a nose to a mouth breather. This can have several side effects such as a change in your voice, making you sound like you have a cold, and causing dry mouth. It can also be hard to eat if you have to breathe mainly by mouth. You can prove to yourself how sensitive the nose is to the smallest blockage simply by blowing your nose. When you do that, often not much comes out, but your ability to breathe is dramatically improved.

What to do about the congestion

Medicines are very helpful here. These include antihistamines and decongestants, often in the same preparation. Antihistamines are used to treat the underlying allergic reaction if this is the cause of the problem. Modern versions of these avoid most of the sedation associated with this class of drugs, and some are available only as a prescription. Decongestants are available over the counter and are used to shrink the swollen lining of the nasal passages to allow more airflow. Antihistamines can cause drowsiness and decongestants can cause insomnia. When taken in combination these side effects can counter each other. Nasal spray decongestants are available over the counter, but their use is generally not recommended for more than a few days. Nasal steroid sprays are commonly used to decrease nasal lining inflammation and can be safely used long term. Salt water spray is another option that is safe to use for clearing mucous blockage from the nose. For those with a serious allergy problem, allergy shots are a consideration. Antibiotics are recommended when the inflammation is caused by infection.

Often medicine does not help, or helps only partially. For people who don’t like the idea of being on medicine for the rest of their lives, surgery may provide a very effective, safe, long-term solution.

The surgery option

The main procedures used to address the crooked septum and enlarged turbinates are called septoplasty and turbinoplasty. Both are accomplished in an outpatient setting and are done through the nostrils, so a facial incision is not needed. In the septoplasty procedure, the septum is straightened to allow for more airflow. The turbinates are also reduced in size with a variety of techniques. These procedures allow for a permanent, often dramatic improvement in nasal airflow. Many surgeons perform these procedures without nasal packing, and they may also eliminate the need for medicine. While these procedures do not treat allergies, the change inside the nose will still eliminate stuffiness. There may also be a benefit in relation to snoring and sleep apnea.

None of these options for treatment are thought of as ‘life saving’ medicine, but improved nasal breathing will make for a more comfortable patient with a better overall quality of life.

For more information and descriptions of various nasal and sinus conditions please look on the web www.drschneiderman.com

Todd A. Schneiderman, MD FACS
215 Union Avenue Suite C
Bridgewater, NJ 08807
908-725-5050