What Causes Nasal Congestion?

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What Causes Nasal Congestion?

Are you congested? If you’re reading this blog, the answer is likely yes.” A life of sniffing, snorting, antihistamines, decongestants, nasal sprays, and antibiotics that do not work is far from ideal. The good news is we are here to help, and this we will! Although seemingly simple, nasal congestion is a complex condition with many potential causes. Proper identification of why you’re congested is essential so we can tailor the proper solution. We have the knowledge, diagnostic tools, and treatments to get you breathing again. We are experts in office-based solutions. One thing is for certain – congestion does not have to be in your future. At Capo Nose and Sinus Center, an operating room does not have to be in your future either – that is our mission! As Long Island’s top sinus doctor, Joseph A. Capo, MD is here to educate and help you. We are in this together.


Why am I Congested?


If the answer was simple, there would be no need to see a nose and sinus specialist. At Capo Nose and Sinus Center, we categorize nasal congestion as follows:

        1. Inflammatory Obstruction

                a. Allergy

                b. Sinusitis

                c. Non-allergic rhinitis

        2. Anatomical Obstruction

                a. Deviated septum

                b. Inferior turbinate hypertrophy

                c. Lateral nasal wall collapse

                d. Other structural anomalies, e.g., concha bullosa

                e. Nasal polyps

                f. Nasal tumors (rare)


Inflammatory obstruction is most commonly caused by environmental allergens such as pollen, grasses, mold, dust mites, animals, and/or sinusitis (take a sinus quiz!). If you have an environmental allergy, the nasal linings become inflamed and can lead to a blockage of airflow. Often, significant allergic sensitivity can lead to sinus infections as the sinus openings in the nose become inflamed and blocked, leading to a buildup of stagnant mucus that can become infected. Once infected, more inflammation ensues which exacerbates the process. 


Sinusitis, another common cause of inflammatory obstruction can be recurrent or chronic. Many patients with recurrent and chronic sinus infections frequently blame their symptoms on “allergies” when, in fact, there are often no allergic components at all. Instead, blocked sinuses lead to infection and swelling resulting in congestion. Patients with significant chronic sinusitis can sometimes develop polyps in their noses. Polyps are inflammatory growths of the internal nasal lining that further block the nasal and sinus passages.


Anatomical obstruction can be caused by several abnormal nasal structures. The most well-known cause is a deviated septum.” Septal deviations are common but are rarely the sole cause of congestion. Other common causes of nasal congestion include enlargement of the inferior turbinates and collapse of the nasal sidewall with inhalation. See the image below.

The septum, inferior turbinate, and nasal sidewall together create the “internal nasal valve” which is the narrowest component of the nasal airway.



How is Inflammatory Obstruction Diagnosed?

As a nose and sinus specialist, Dr. Capo will first obtain a detailed history from you. Questions will include duration and severity of symptoms, the timing of symptom occurrence (always congested, congested only at night or certain times of the year, etc.), prior nasal surgery, and any medications you have tried in the past. After your history is evaluated, a small camera will gently be placed into your nose (called a nasal endoscopy) to evaluate the internal nasal structures to be sure there is not an anatomical cause that may also be contributing to your symptoms. Many patients will have both anatomical and inflammatory factors involved. If Dr. Capo believes an allergy is a contributing factor, he will perform a simple, office-based skin test for 46 of the most common environmental allergens found on Long Island.



Identifying what you’re allergic to, and to what degree, is essential in formulating the proper allergy treatment regimen, especially if prior allergy medication has failed. 


Often, as mentioned before, underlying sinusitis can contribute to inflammatory obstruction and will be diagnosed with an office-based, low radiation CT scan. The scan only takes 20 seconds, and Dr. Capo will review the images with you immediately to discuss your treatment plan!


How is Anatomical Obstruction Diagnosed?


Dr. Capo will start with a similar comprehensive history. A nasal endoscopy will also be performed to evaluate the septum, inferior turbinates, and other internal nasal structures. Nasal sidewall collapse is diagnosed with the “Cottle Maneuver.” The cheek is gently pulled to the side, and you will be asked to inhale. If this improves your breathing, you likely have an element of nasal sidewall collapse. 

  


We will often also obtain a minor CT scan to rule out other underlying conditions like concha bullosa (air-pocket in the middle turbinate that obstructs breathing and sinus drainage) or sinusitis which can also be contributing to obstruction.



How is Nasal Congestion Treated?


As you now know, there are many causes of nasal obstruction and since many of these conditions are very common, most patients have several factors, both inflammatory and anatomical, that are contributing to their symptoms.


How are Allergies Treated?


If there is a significant allergic component diagnosed via the skin test, patients will first be started on a nasal steroid spray and/or a nasal antihistamine spray. Many of our patients have already failed these treatments and are perfect candidates for holistic allergy immunotherapy” commonly referred to as “allergy shots.” The specific natural allergens that react on your skin test are formulated for injection into the arm. Over time, you will become immune to these allergens, curing your allergy. Allergy Immunotherapy is the only known cure for allergies. Other treatments like oral antihistamines (Benadryl, Claritin, Allegra), nasal sprays (Flonase, fluticasone, mometasone, Nasacort, Nasonex, azelastine) act as band-aids that merely mask your body’s response to an allergen. 


What is Clarifix?


Clarifix is a simple, pain-free, 5-minute office-based procedure that is FDA approved for treating allergic rhinitis and excessive nasal drainage. The procedure applies a cool temperature to the nerve in the back of the nose that is responsible for these symptoms. Over the next 4-6 weeks, degeneration of that nerve significantly improves a patient’s nasal congestion and drainage. 


 
Is Septoplasty Right for me?


Septoplasty is a procedure performed to straighten a deviated septum. Most ENT doctors use traditional techniques that require general anesthesia in an operating room and excessive nasal packing with a long recovery. Joseph A. Capo, MD takes a more modern approach. He is one of the only ENT surgeons on Long Island who is an expert in modern endoscopic septoplasty. This allows him to perform minimally invasive septoplasty, pain-free with local numbing right in the office. This 30-minute procedure is safer because it doesn’t require anesthesia in an OR, results in significantly less bleeding, quicker recovery, and significantly reduces health care costs. See the video below which includes a patient testimonial from a recent case. 


Testimonial with Joseph A. Capo, MD


For comparison, here is a typical, or basis, septoplasty experience (not by Dr. Capo)


How is Nasal Sidewall Collapse Treated?


If nasal sidewall collapse with inhalation contributes to your congestion, Joseph A. Capo, MD will offer Latera nasal valve implant in the office. This cutting-edge, office-based procedure stabilizes the nasal sidewall, significantly reducing its collapse and improving your nasal breathing. It takes 10 minutes in total to complete and is painless. 

Latera Video Animation


What is Inferior Turbinate Reduction?


Most patients with significant allergy, nasal congestion, and sinusitis have hypertrophy or enlargement of their inferior nasal turbinates. Turbinate reduction is a simple, pain-free, and office-based procedure to reduce the size of the turbinate and improve breathing. When done alone, recovery is only 24-48 hours of nasal congestion as the turbinates heal. 


What are Balloon Sinuplasty and Office-based Sinus Procedures?


For patients who suffer from chronic or recurrent sinus infection with sinus inflammation or narrowing on their CT scan, balloon sinuplasty and/or other office-based sinus procedures are indicated. Joseph A. Capo, MD is Long Island’s top doctor for office-based management of these conditions, performing the highest volumes of these procedures in the region. After the entire nasal cavity is numbed with local numbing gel, a small balloon is placed into the sinus opening, dilated, and removed to restore normal sinus drainage and physiology. Capo Nose and Sinus Center uses image guidance in our office (typically only available in an operating room) which is the standard of care for sinus surgery. Image guidance allows us to perform these procedures without the risk and increased cost of an operating room. 



Balloon Sinuplasty Review


Testimonial Septoplasty, Hybrid Balloon Sinuplasty and Sinus Surgery


Conclusion


Dr. Joseph A. Capo of Capo Nose and Sinus Center has a passion for treating nasal and sinus disorders. Patient education is the first step (and the purpose of this blog) in improving patient outcomes and joint-decision making. If nasal congestion is bothering you, please reach out and schedule a consultation. We have the tools and expertise in all treatment modalities to get you breathing clearly once more. Come see for yourself!