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Nasal Congestion – Part 1

Many patients complain about a congested nose, this is a very common symptom and everyone has already experienced such situation. This is, because the nose contains structures, the lower and medial turbinate, which have the ability to expand and shrink. It is a mechanism that is regulated through blood circulation in the nose and gives us the ability to adjust the temperature of the inhaled air and the ability to control the volume and speed of the nasal flow. Some research has revealed that the human nose undergoes cycles of partial swelling of the turbinate where often only the nasal passage on one side is clear. When patients complain about congestion however they are talking about a grade of congestion that has more impact and lasts longer than such natural cycle.

This situation is for various reasons a potentially harmful situation for our life. Firstly an obstruction can also develop through any unclear growth inside the nose. There are various tumors that develop inside the nose. It could be benign polyps, destructive inverted papilloma or juvenile angiofibroma, or malignant growth like intranasal squamous cell carcinoma, nasopharyngeal carcinoma or any kind of malignant metastasis in the upper nasal passage.

Another reason why we should be concerned about the congested nose is that it debilitates the function of our nose which is firstly the breathing. The breathing is one of our most important and from birth to death continuous interactions with our environment. We inhale oxygen and exhale carbon dioxide and other unwanted substances with this interaction.

Similar to the digestive system we allow our body to have direct, not like e.g. with our hands that are protected by a sealed skin, contact with the environment while breathing. For such interaction we need to be prepared to gain the most and to protect at the same time our body. Therefore we have a special organ that serves as the lock for breathing: the nose.

Breathing through the mouth is as unnatural as eating through the nose.

While air passes our nose we get not only information about the volume, the speed, the temperature and the humidity of the air, but also about the content. Are toxic gases in the air, allergens, odors, insects and particles? And our nose has the ability to react to this information with swelling or shrinking, from our sinuses additional air can be mixed into the inhaled air thus adjust temperature and humidity.

When the lining of our nasal passage is inflamed it may not only expand, but also become red and produce waterish secretion.

The redness and inflammation may reach a level where the lining, which is called mucosa, lacks protection and occasionally begins to bleed.

Nose bleeding is often related to inflammation of the nasal lining, especially when the inflammation is expressed as a result of infection.

Inflammation of the nose also leads to swelling at least when we are lying down. Therefore inflamed nasal mucosa goes ahead with nasal congestion at least in the night. But it makes us also very sensitive to air-conditioned temperature, perfumes, and dust particles. We tend to sneeze when we are exposed to such air characteristics.

There are four major reasons why we develop inflammation anywhere in our body.

  • It can be any mechanical or physical reason, such as mechanical strain from a physical activity a burn or freeze or or any impact of environmental influences like rubbing clothes or wind that blows in the eyes, etc. For the nose this could be the high speed of airflow when a structural bottleneck situation is present or the picking finger. A common physical cause for inflammation in children is the presence of a foreign body (small toy particles) or candies and nuts
  • It may also be a chemical reason. For example acid or reactive chemical substances may cause an inflammation when they have contact with our body. For the nose this could be formaldehyde in cigarette smoke, drugs, nose sprays, petrol or any gas.
  • It may as well be a biological reason. Here we differentiate between allergic reason, where a potentially harmless substance ignites a reaction of our body that leads to inflammation, and infectious reason where germs enter our body and ignite an inflammation. For the nose allergies are almost always due to contact with fine particles that are hovering in the air and then inhaled. Infection is in the majority a result of contamination with viruses, but also bacteria and in some places of the world molds or fungus may be responsible for a few cases of such inflammation. The interesting point here is that often the center of infection sits in the sinuses and not directly in the nasal cavity
  • In this list we may ignore the presence of inflammation from radiation and tumor toxins, because such inflammation