How to combat a “blocked nose”

A “blocked nose” is one of the most common symptoms patients typically present with, according to Dr Dharambir S Sethi, senior consultant ear, nose and throat surgeon at Novena ENT – Head and Neck Surgery Specialist Centre. “Sinuses are basically air pockets around the nose,” he explains. “Air flows into the nose, through narrow channels and into the sinuses to keep them ventilated. These channels are tiny and the slightest swelling in these channels can cause a blockage and result in sinus infection.”

Causes of nasal congestion

Nasal congestion occurs when the lining of the nasal cavities becomes swollen due to nasal allergies, sinus infections or rhinitis, Dr Sethi explains. “Rhinitis simply means inflammation of the lining of the nose. In addition to the causes mentioned, persistent nasal congestion may sometimes result from use of over the counter nasal drops to relieve the congestion. Some patients use a lot of these nasal drops to help them breathe better, but in the long run, the same nasal drops cause persistent mucosal swelling and they can get a condition called ‘rhinitis medicamentosa’.” Some patients may also be allergic to the environment they work in and this can cause occupational rhinitis.

Another reason patients can have issues with nasal obstruction is due to congenital problems within the nose. “The nose bone may be very crooked,” Dr Sethi continues. “They may be born with it or acquire it during their lifetime due to injuries. This is known as a deviated nasal septum,” he says. Other patients might have large turbinates - certain bones on the side of the nose - that block the nasal cavities.

Lastly, patients could have a growth inside the nasal cavity, like polyps or polypoid lesions that cause obstruction and problems with airflow.

Treating nasal congestion

In cases where the blockage is due to allergic swelling of the lining of the nasal cavity, avoidance forms the mainstay of treatment. “Whatever you are allergic to, avoid it,” Dr Sethi says. “For example, if a patient is allergic to house dust mites, we counsel them on environmental control. If they are allergic to certain foods, we advise them to avoid those foods and they are fine.”

For patients who have a very congested or runny nose or continuous sneezing, treatment often turns to medications like antihistamines or decongestants. “Medications such as antihistamines block the histamine receptors and the patient gets less sneezing,” Dr Sethi says. “Decongestants reduce congestion in the nose and give patients symptomatic relief. In addition, these patients can also be treated with oral and topical steroids if they have very severe allergies.”

Another option for patients with allergy based nasal congestion is immunotherapy and it is often used where medical therapy has failed. “This form of treatment basically desensitises the patient toward what they are allergic to. It is a time consuming process, which requires a commitment of two years, as patients have to take either subcutaneous injections or consume tablets orally for at least two years,” Dr Sethi says.

For patients whose swelling is due to sinus infection, treatment is dependent on the cause of the infection. “Acute sinus infections do not last more than three weeks and often occur when the patient gets influenza but doesn’t fully recover, leading to a sinus infection,” Dr Sethi says. “It is usually treated with a course of antibiotics, decongestants and other treatments to reduce symptoms. 95 percent of patients with acute sinusitis will improve with medical treatment.”

Chronic sinus infections are diagnosed when symptoms involving the sinuses last for more than three months. Chronic sinusitis is an inflammation of the sinuses which may be caused by infection, allergies, fungus, congenital problems in a weak immune system or normal bacteria that are present inside the nose. “We all have staphlococcus living inside our nose, but in some patients, their own bacteria turns against them, so this can cause chronic sinusitis,” he says.

Treatment of chronic sinusitis is dependent on its cause, with the goal being to identify as many causes as possible and treat them concurrently. “If the cause is an infection, we give antibiotics,” Dr Sethi says. “If it is a fungus, we give anti-fungal treatments. If allergies are involved, we give allergic rhinitis drugs. Sometimes all of these factors are involved and they need to be identified and treated accordingly.”

Dr Dharambir S Sethi is an Ear, Nose, Throat (ENT) surgeon with over 25 years’ experience in the field, providing specialised care for patients with nose and sinus disorders. Prior to establishing his private practice, Dr Sethi was Senior Consultant of Otolaryngology at Singapore General Hospital, where he is still a visiting consultant.

Novena ENT – Head & Neck Surgery Specialist Centre

Main Clinic:
Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road #04-21/22/34
Singapore 329563
Tel: +65 6933 0451
Email: enquiry.mnh@novena-ent.com

Satellite Clinic:
Parkway East Medical Centre
319 Joo Chiat Place #03-07
Singapore 427989
Tel: +65 6346 7761
Email: enquiry_peh@novena-ent.com
www.novena-ent.com