By Gerard W. Frank, M.D.
Nasal congestion is one of the most common symptoms prompting doctor appointments. Ear, nose and throat specialists, pulmonary specialists and allergists see these patients daily in their offices.
While the symptoms seldom indicate a serious problem, they can complicate conditions such as asthma and are the most common reason for a persistent cough.
What causes nasal congestion? The cells lining the inside of our noses pour out fluid when they become irritated or inflamed. We all experience this with the common cold. Certain allergies may make us sneeze and some of us are just unlucky to have very sensitive nasal passages. The cells pour out fluid and swell, making it hard to breathe. The culprit causing this reaction is histamine. That’s why drugstores stock shelves of antihistamines to treat this annoying condition. Of course, antihistamines often can cause sleepiness or unpleasant dryness. Another popular remedy is a decongestant that alleviates the swelling and opens the passages. Patients with hypertension must use caution with decongestants because they may raise blood pressure.
If the congestion, technically known as “rhinitis,” does not improve with treatment or is associated with forehead or cheek pain, the doctor may suspect sinusitis – inflammation of the sinuses. The sinuses are literally holes in the bones of our skull and face. Normally, they are empty, but can become inflamed with fluid, causing pressure on the bone – and pain. Serious sinusitis is difficult to treat and puts the patient at risk for infection. The diagnosis is best made by a CT scan. It rarely requires surgery to drain the fluid.
Rhinitis that does not respond to treatment should prompt physicians to suspect allergies and consider formal allergy testing, either by skin or blood tests. Some well-defined allergens can be avoided. More often than not, however, no allergy is detected or the allergen cannot be avoided. Dust mites are one example. Treatment cannot cure allergies, but may alleviate the symptoms. There are nasal spray preparations that either dry up the membranes in the nose or counter the inflammation. Rarely, antibiotics may be required. Some patients find regular nose rinsing clears the passages, at least temporarily.
Post-nasal drip is a related problem. In many patients, only membranes in the back of the nasal passages are inflamed. The patient does not experience runny nose but fluid actually drips down through the back of the mouth into the throat. This fluid contains the irritant histamine and stimulates the need to cough.
Unfortunately, there is no specific test to detect post-nasal drip. However, physicians should try to treat post-nasal drip in any patient with unexplained cough. Of course, more serious reasons for the cough, such as infection, must be ruled out first.
Rhinitis can be very stubborn and difficult to treat. Although it’s not as serious as sinusitis, it’s nothing to sneeze at!
Dr. Gerard W. Frank is a board-certified internal medicine specialist and pulmonologist at UCLA Medical Center, Santa Monica and medical director of the UCLA Pulmonary Rehabilitation Program.