Congestion, Stuffy Nose, & Nasal Obstruction

Nasal obstruction can be a considerable nuisance that detracts from the ability of patients to enjoy their normal daily activities. While there are often multiple factors that play a role in any given patient’s congestion, it is easier to understand if the factors are divided into inflammatory causes and structural causes. 

Inflammatory causes of nasal congestion and obstruction are due to swelling of the blood vessels in the nasal lining that decreases the nasal airway. A variety of triggers can cause the inflammation of the nasal lining to include viral or bacterial infection (rhinitis or rhinosinusitis), polyps, allergies, pollution or chemical irritants (such as perfume or tobacco smoke), medications, and certain medical conditions (such as pregnancy). Inflammatory or mucosal causes of nasal congestion are best treated with medical therapy, depending upon the specific cause. Antibiotics, topical steroids or decongestants, and antihistamines may all be appropriate. Please see the section regarding each specific cause.

Structural causes of nasal obstruction are due to anatomic abnormalities of bony or cartilaginous areas throughout the nasal airway. Common examples include septal deviation, enlargement of the turbinates, enlargement of tonsils and/or adenoids, nasal deformities, tumors, foreign bodies (such as beads, food and other objects), and congenital problems. Most of these structural causes will not respond to medications and will require surgical therapy for correction.

Septoplasty & Turbinate Surgery

Enlarged, swollen inferior turbinate blocking the nasal cavity.

The nasal septum is made of bone and cartilage and divides the nasal passages into right and left halves. It is rarely straight – over 80 percent of people have some degree of deviation or crookedness. If the septum is so deviated that it causes nasal obstruction or contributes to chronic sinusitis, an operation called a septoplasty may correct the problem.

Septoplasties are done in the operating room under general anesthesia. Patients generally go home the same day. Surgeons use small incisions inside the nose to gently lift the lining off the septum and remove or straighten the deviated cartilage and bone. Once the bone and cartilage are removed or straightened, the lining of the septum is returned to its normal position and held in place with absorbable suture material or soft plastic splints.

The turbinates are bony structures that originate along the sides of the nasal passage and project into the nasal airway. They are covered by normal sinus lining and act as baffles to warm and humidify the inhaled air. Occasionally, the turbinates may be enlarged and contribute to nasal obstruction. If this is the case, turbinate reduction may be performed. A variety of methods exist for reducing the turbinates, but the best long-term results are generally from a partial resection of the underlying bone and preservation of the outer lining. This technique avoids the complication of a dry nose from completely resecting the turbinates.