Nasal Stuffiness

Allergies

• Symptoms include stuffiness, runny rhinitis and sneezing. Simultaneous ocular symptoms, such as itching and tearing, are common.
• The most common causative agents are pollen and animals.
• Diagnosis is based on a careful history and allergen-specific IgE antibodies or skin-prick tests. The possibility of an occupational disease must be considered in, for example, bakery workers and farmers (e.g. wheat flour, cow), and appropriate measures regarding work-related insurances taken, as necessary.
• In problematic cases the patient should be referred to a specialist: for example, for the more accurate diagnosis of a work-related allergy, allergen immunotherapy.
• See also Allergic Rhinitis.

Non-allergic rhinitis with eosinophilia syndrome (NARES)

• Symptoms include a stuffy nose and mucus in the pharynx.
• Tests will not show a specific allergy. May be associated with asthma or ASA intolerance.
• The patient often has nasal polyps, mucosal oedema in the paranasal sinuses and nasal meatuses and, as a consequence, an impaired sense of smell.
• The treatment consists of a long course of topical glucocorticoids together with appropriate instructions and monitoring, so that the mucosa in the anterior part of the nose does not suffer too much of the drying effect of the treatment.
  • Polypectomy if indicated

Vasomotor rhinitis

• A regulatory disturbance within the nose where the patient reacts too strongly to, for example, changes in the ambient temperature, odours or dust, which leads to nasal congestion or watery nasal drainage.
• Findings include swollen, often bluish (livid) nasal conchae; the mucous membranes look healthy.
• The sense of smell is good (may even be ”too good"). May be associated with a condition termed odour hypersensitivity (MCS, multiple chemical sensitivity), for which no diagnostic criteria have been substantiated.

Irritant rhinitis, chronic mucosal irritation

• Possible causes
  • Impurities of the air, e.g. industrial dust containing metallic particles
  • Dryness of the mucosa in the anterior part of the nose, caused by a too high maintenance dose of a topical glucocorticoid, with nose bleeding and even septal perforation as complications
  • Drying and crusting of mucosa, caused by septal perforation, often with bloody crusts.
  • Smoking
  • Constant use of decongestants
  • Too wide nasal cavities (so-called empty nose) resulting from surgery
  • Systemic diseases, dehydration
  • Sequela of radiotherapy

Chronic sinusitis

Nasal polyps

• Swellings of mucous membranes induced by mucosal oedema, which prolapse into the nasal meatuses.
• They usually arise from ethmoidal cells or from their vicinity
• Symptoms include a blocked, stuffy nose, impaired sense of smell and mucus in the pharynx.
• Anterior rhinoscopy after decongestion is a diagnostic investigation; nasal endoscopy if indicated. A biopsy should be taken particularly if the polyps are unilateral (an inverted papilloma or another tumour may resemble a polyp).
• In cases of ASA triad (polyps, asthma, ASA intolerance), in particular, the condition is likely to recur.
• Treated like non-allergic rhinitis with eosinophilia syndrome (see above).
• See also Nasal Polyps.

Chronic nasal mucositis or nasopharyngitis

• Symptoms include reddish, possibly scabbed or crusted mucous membranes in the nasal meatuses or nasopharynx.
• Possible causes
  • Mucositis caused by unclean irrigation fluid (e.g. E. coli); yellowish discharge clots (bacterial biofilm) on the septum and conchae
  • Granulomatosis with polyangiitis (Wegener's granulomatosis)
  • Atrophic rhinitis/ozaena (the causative microbe is Klebsiella ozaenae) Atrophic Rhinitis and Ozaena
  • Purulent lymphatic tissue or adenoids in the nasopharynx
• In granulomatosis with polyangiitis, the presence of serum antineutrophil cytoplasmic antibodies (ANCA) should be determined and a mucous membrane biopsy taken, and in ozaena and mucositis, a bacterial culture of the purulent nasal discharge is indicated. A bacterial culture or a biopsy can be taken from purulent nasopharyngeal tissue, or the infected adenoid can be removed (sent for pathological examination).
• Local treatment consists of cleaning with saline spray, application of an antimicrobial ointment if the treatment is limited to the nasal opening, or nasal saline irrigation or spray and, in some cases, topical glucocorticoid Intranasal Corticosteroids for Nonallergic Rhinitis into the nose/nasopharynx.

Inflammation of the vestibular skin

• A painful ulcer/scar evident on the skin inside the nostril, bacterial infection
• Treatment consists of cutting off the hairs in order to expose the lesion, the patient is asked not to touch the area, an antimicrobial(+ glucocorticoid) cream
• Biopsy if indicated

Nasal septal deviation

• The most obstructive deviations usually occur in the anterior third of the septum; malposition of the external nose may also be present. The deviation may be the result of trauma or it may have developed during the person's growth.
• The nose is examined before and after decongestion: is the septum in contact with the lateral wall? Acoustic rhinometry or rhinomanometry is used to measure nasal airflow to assist surgery planning.
• Septal surgery is a common day case procedure.

Enlarged adenoids

• A significant cause of nasal stuffiness and mouth breathing in children (and adolescents)
• A mouth breathing child should be referred to an ENT specialist.
• If necessary, adenoids can be visualised with a mirror examination (posterior rhinoscopy) or nasoendoscope.
• Adenoidectomy is a simple day case surgery carried out under general anaesthesia.

Nasal valvular or vestibular insufficiency

• The cartilaginous vault of the nose or the nostril openings collapse during inspiration.
• Diagnosis: examination by a specialist well familiar in rhinology. Nasal strips and nasal dilators are beneficial.
• Treatment consists of a surgical repair. Surgery requires rhinologic expertise.

Nasal or nasopharyngeal tumour

• May be benign (e.g. inverted papilloma, juvenile angiofibroma) or malignant (e.g. esthesioneuroblastoma, adenocarcinoma, lymphoma or carcinoma of the nasopharynx)
• Symptoms of benign changes include unilateral stuffiness, discharge and impairment of sense of smell. If the nasopharyngeal tumour disturbs the function of the Eustachian tube, symptoms include ear clogging and possibly fluid retention in the middle ear.
• Symptoms of a malignant change include also unilateral nosebleed, swelling of the cheek region, pain and, rarely, visual disturbances.

Foreign body in the nose

• Unilateral stuffiness, bad-smelling purulent discharge
• Must be borne in mind particularly in children and mentally retarded persons.
• If it is suspected that a battery has got in the nose, this is an emergency situation and the patient should be treated immediately.
• See also Foreign Body in the Nose.