Free nose breathing is something most of us take for granted. But when this becomes difficult or even impossible, our entire daily life suffers. Nasal obstruction, as it is called in medical language, frequently occurs in the context of allergic rhinitis, rhinosinusitis or other inflammatory conditions. “There are many situations when the nose is blocked and we have to breathe through the mouth. However, nasal obstruction that lasts more than 3 weeks requires evaluation by an ENT specialist.” warns Dr. Marius Bota, primary ENT physician, MedLife Timișoara.
Few people know that the nose has multiple roles: respiratory, protective, olfactory, phonatory and aesthetic. “Normal (physiological) breathing is nasal breathing. The inability to pass a comfortable and normal volume of air through the nasal passage is called nasal obstruction and can cause discomfort with an impact on daily activities. This symptomatology can be reflected in eating, breathing, speaking and sleeping”draws Dr. Bota's attention.
About 10–20% of the population has allergic rhinitis
Rhinitis, whether allergic or non-allergic, is the most common cause of nasal congestion. According to data from the specialized literature, the global prevalence of unspecified rhinitis is approximately 29%, allergic rhinitis (AR) 18%, and non-allergic rhinitis (NAR) 12%. This indicates that approximately 1 in 5 adults suffer from RA.
Nasal congestion is the most common symptom in RA patients, with 59–60% of those affected reporting obstruction. A stuffy nose can occur on one or both sides, it can come on suddenly or gradually, and it can last for a while, but it can come back periodically or become a constant problem. It is certain that “nasal obstruction significantly affects the quality of life and is currently probably the most common complaint of the patient requesting an ENT examination”, says Dr. Marius Bota.
In ENT clinics, over a third of patients have severe obstruction
In a study that used the NOSE scale (Nasal Obstruction Symptom Evaluation Scale) of 3,533 patients who presented to ENT clinics in the US, 37.4% had severe or extreme symptoms of nasal obstruction. In the MedLife Hyperclinic in Timișoara, Dr. Bota deals with many patients with nasal obstruction, at least a quarter of the total number of people who come for consultation.
“The proportion of patients presenting to the office complaining of nasal obstruction varies depending on the season, in spring – allergic patients, in autumn, in winter – those with acute respiratory tract infections. Patients with chronic nasal obstruction, on the other hand, represent a percentage of at least 25% of the number of those who request a consultation”. confesses the doctor.
Apart from allergic or chronic rhinitis, there are other causes of nasal obstruction such as: deviated septum, infections, trauma, tumors, but also the abuse of decongestant drops.
Why do children suffer more often?
In small children, the causes of nasal obstruction can be given by malformations of the nasal vestibule and nasal pyramid, choanal atresia (imperforation of the posterior opening of the nasal fossae), benign/malignant tumor formations, nasal foreign bodies – a pathology generally found in children over 6 months, in which case nasal obstruction dominates the clinical picture in the first days, later infection and other problems may occur.
“Without a doubt, the hypertrophy of adenoid vegetations (in popular language, polyps) is the most common cause of nasal obstruction in children. This lymphoid tissue is located on the postero-superior wall of the nasopharynx and is present in all children, regressing with age. When the volume of vegetation is too large, it completely occupies the nasopharynx and obstructs the posterior openings of the nasal passages, causing nasal obstruction. it also obstructs the tube openings of the Eustachian tubes, preventing the ventilation of the middle ear and the accumulation of a liquid at this level. This pathology has consequences on the child's normal physical and intellectual development by depriving the body of oxygenated air and can be frequently accompanied by repeated episodes of viruses and otitis.”explains the ENT doctor.
Nasal endoscopy, in most patients with persistent nasal obstruction
If the stuffy nose is accompanied by repeated sinus infections that do not respond to antibiotics, severe headaches or in the sinus area, excessive tearing, swelling of the face, impaired vision, loss of smell or frequent nosebleeds, medical consultation is essential. These symptoms can hide serious conditions, including sinus tumors.
Clinical examination is essential, and in addition, ENT doctors often make use of many modern investigations. “Nasal endoscopy (nasopharyngoscopy) is an imaging modality for exploring the sinuses and the nasal cavity. It is used both for diagnostic purposes and in monitoring the evolution under medical or post-surgical treatment. Without special preparation of the patient (local anesthetic and possible anemia of the nasal turbinates), nasal endoscopy is used in most patients with persistent nasal obstruction“, explains Dr. Bota.
The investigation consists of inserting a thin tube with a video camera that provides detailed images of the inside of the nose and sinuses. The native CT, which is the method of choice in highlighting the rhinosinusal sphere, CT with contrast substance or MRI examination can be performed, especially in the context of a tumor suspicion and, in certain cases, complementary blood tests, nasal cultures, allergy tests and multidisciplinary consultations are required.
A story that marked the career of Dr. Marius Bota
Beyond the technique and medical protocols, the Timișoara orethicist remembers a case that stayed in his soul. “When I was in my last year of residency, I was approached by the father of a 16-year-old boy who had suffered epistaxis (a nosebleed). I was in the hallway of the outpatient clinic when the boy, who had been in the emergency room a few days before for this problem and had been tested, caught my attention with his husky voice. Looking over the tests, I asked the child what had happened. At a glance, I noticed laterocervical adenopathy right, at which point we decided to perform the nasopharyngeal endoscopy. The subsequent diagnosis of stage 4 nasopharyngeal neoplasm was not easy to “digest” even for the medical body. But, following radio and chemotherapy treatment, the child is 32 years old today.” said the doctor, who tries to find solutions for nasal obstructions according to the causes.
From sprays to minimally invasive surgery
Treatment for stuffy nose depends on the cause. Sometimes drug treatment is enough – sprays, inhalations, antibiotics (for infections), anti-allergic or anti-inflammatory drugs. Other times, when the problem is structural (for example, deviated septum, polyps, trauma or tumors) surgery is needed.
Today, operations are performed using modern, minimally invasive, endoscopic methods, which ensure quick recovery. Among the most common procedures are:
· septoplasty – straightening of the nasal septum,
· turbinoreduction – reduction of the nasal turbinates,
· polypectomy – removal of polyps,
· functional rhinoseptoplasty – which combines breathing correction with the aesthetic part of the nose.
A widely used procedure is radiofrequency turbine reduction.
“I use radiofrequency nasal turbine reduction regularly, usually under local anesthesia. It is a short, 10-15 minute outpatient procedure, without hospitalization, and allows for a quick, easy, and elegant solution to nasal obstruction and drop addiction”emphasizes Dr. Bota.
Nasal obstruction is not just a simple “stuffy nose”, but a problem that can affect breathing, sleep, daily performance and even children's development. The good news is that, regardless of the situation, there are effective solutions, but it is necessary to visit the ENT doctor from the first symptoms.
Sources:
https://pmc.ncbi.nlm.nih.gov/articles/PMC8967272/
https://pmc.ncbi.nlm.nih.gov/articles/PMC2866547/
https://pubmed.ncbi.nlm.nih.gov/37705360/
