Nasal Congestion or “What’s Blocking My Nose?”

ANSWER: “Gee Fred, there could be a number of reasons.  There could be a natural anatomic structure in the way or something abnormal, such as a polyp, mass or—heaven forbid—another foreign body you’ve forgotten about.  Your question has great merit, though the way you’re demonstrating your concern is, shall we say, not natural.” 

WARNING: Do not put foreign objects in your nose (or ears, or your mouth, or any other bodily orifice for that matter).  Doing so can be very, very bad.  It could lead to unpleasant things such as serious injury, uncontrolled bleeding, infection and DEATH.  So avoid putting stuff—artificial or otherwise-- into places where they’re not meant to be.  Exercise a bit of common sense and be responsible since, from my understanding, dying is not a good outcome.

     Also this serves as a warning to the parents of young children: keep small objects away from the youngsters.  The general rule is nothing that is small enough to place in their mouths.  You need to be highly vigilant in this matter until they’re old enough to exercise good judgment on their own, which in some cases may not occur until they’ve moved out of your house.

     You may wonder why one side of your nose feels more blocked relative to the other side.  Or perhaps you wonder not at all about such matters since you have better things to occupy your time such as chasing butterflies.   For those of you with difficulty breathing through your nose, then keep on reading.  Many times patients complain of “nasal congestion.”   What is nasal congestion?  This is a rather vague term having more than one meaning.  So when diving deeper into the nature of one’s symptoms, the doctor will ask more detailed questions such as:  “So Fred, when you describe your ‘congestion’, do you mean difficulty breathing from the nose?  Does the nose feel plugged or blocked?  Or is it sinus (facial) or head pressure?  Do you have a runny nose, postnasal drainage (drainage down the back of your throat) or are you just sniffing a lot?  Well, what is it, Fred my boy?”

     For this discussion, we’ll limit “nasal congestion” to a restriction or obstruction to nasal breathing.  Getting back to Fred’s question after strictly advising him of the WARNING above, the reasons often are related to anatomy.  If we take a cross-section view through Fred’s face and nose (ie, an imaginary “slice”through his nose and face and looking at it in frontal plane) you can see the nose has all sorts of wonderful things besides snot and buggers.  By the way, the nose is longer from front to back than it is from top to bottom, contrary to conventional wisdom.  We’ll discuss only a few of the main features related to nasal congestion.

     First of all there’s the septum.  This is the partition that divides the nose into left and right sides.  In most people, the septum is straight and midline.  However, some patients may have a septal deviation, where the septum is crooked or bent to one side.  This causes a narrowing of the nasal passage on the side of the deviation and impairs air inflow on that side.  The septum also does to extend all the way to the back of the nose but stops short.  This is why you might notice that something such as water (or for those of you who irrigate the nose) can enter on side of the nose and come out the other.

     Then there are the turbinates.  The largest of these is the inferior turbinates, so named because they are positioned lower relative to the other turbinates.  This is ironic since the term inferior can also mean an inferior social position, but it just so happens the inferior turbinates are the largest.  They also can become congested or swollen, and thus can enlarged in size.  This phenomenon occurs with colds and allergies and the like.  The turbinates are responsible for warming and moisturizing inhaled air before it hits your throat, trachea (windpipe) and lungs.

     Of particular importance are the middle turbinates.  These are located very close to where the sinuses open into the nose.  The sinuses—or paranasal sinuses to be more descriptive—are airspaces located in the skull and facial bones that surround the nose.  More information about the sinuses and sinus conditions will be covered in another chapter.

      The moist, pink lining tissue of the nose is called the mucosa.  This tissue is responsible for creating nice stuff like mucous, which contains various substances that gives it a protective as well as moisturizing quality.  Keep in mind that mucous is normal and the nose constantly creates it.  Its production increases with viral illnesses such as colds, allergies, and bacterial infections, and serves as a defense to fight off these nasal aggravators.  Too little mucous production creates dryness and crusting and bleeding which is quite uncomfortable.  That’s why Fred’s three year-old son picks his nose during the dry winter months, and then sticks the dried “buggers” on the wall for lack of better places to put them.

     Farther back at the end of the nose are the adenoids.  Adenoids are lymphoid tissue, similar in nature to the tonsils found on each side of the throat, and are important for creating protective antibodies needed mostly during young childhood.  For this reason, adenoids are often larger in young children, and if too large, can cause nasal breathing problems, chronic mouth breathing and chronic snotty noses.  The adenoids tend to shrink and wither away as we get older.

     Then there are abnormal things that can occupy the nasal space, causing nasal obstruction.  A common one is a polyp, which can be loosely defined as benign soft enlargement of tissue caused by allergies or infections.  There could be other masses or “growths” such as granulomas (benign firm pink tissue that can  bleed easily) or very rarely cancerous tumors.  There could be a foreign object stuck in the nose; this typically occurs in young children and not so much in adults such as Fred, who clearly is not right in the head.  These are but a few things that can bring about nasal breathing problems.

     For those with difficulty breathing through the nose, your doctor needs to take a history and do an examination of the nose to find the source, which then helps guide proper treatment.  Sometimes your doctor might do other diagnostic stuff, such as using a scope in the nose to view it better, or obtain imaging such as a CT (Computed Tomography) scan to provide additional information. 

     So in Fred’s case, his pencil may be hitting a bend in his septum or one of his turbinates.  He might have a polyp or some other mass.  Or he may simply have normal anatomy that is slightly different compared to his opposite side.  In either case, if he has concerns, he should have this evaluated by a medical professional.

     And take a lesson from Fred’s example—to err is human, but to willing err AFTER being told not to do so is stupidity.

©Randall S. Fong, M.D.


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