| You and Your Stuffy Nose
Define Hay Fever and Allergies
Causes of Sinus Pain
Can Over-the-Counter Medications Help?
Sinus Surgery
Nasal congestion, stuffiness, or obstruction to nasal breathing is one
of man's oldest and most common complaints. While it may be a mere
nuisance to some persons, to others it is a source of considerable
discomfort, and it detracts from the quality of their lives.
Medical writers
have classified the causes of nasal obstruction into four categories,
recognizing that overlap exists between these categories
and that it is not unusual for a patient to have more than one factor
involved in his particular case.
Infection
An
average adult suffers a common "cold" two to three times per year, more
often in childhood and less often the older he gets as he develops more
immunity. The common "cold" is caused by any number of different
viruses, some of which are transmitted through the air, but most are
transmitted from hand-to-nose contact. Once the virus gets established
in the nose, it causes release of the body chemical histamine, which
dramatically increases the blood flow to the nose, causing swelling and
congestion of nasal tissues, and stimulating the nasal membranes to
produce excessive amounts of mucus. Antihistamines and decongestants
help relieve the symptoms of a "cold," but time alone cures it.
During a virus infection, the nose has poor resistance
against bacterial infections, which explains why bacterial infections
of the
nose and
sinuses so often follow a "cold." When the nasal mucus turns from clear to yellow or green, it usually means that
a bacterial infection has taken over and a physician should be
consulted.
Acute sinus infections produce nasal congestion, thick discharge,
and pain and tenderness in the cheeks and upper teeth, between
and behind the eyes, or above the eyes and in the forehead, depending
on which
sinuses
are involved.
Chronic sinus infections may or may not cause pain, but nasal obstruction
and offensive nasal or postnasal discharge is often present. Some
persons develop polyps (fleshy growths in the nose) from sinus
infections, and
the infection can spread down into the lower airways leading to
chronic cough, bronchitis, and asthma. Acute sinus infection generally
responds
to antibiotic treatment; chronic sinusitis usually requires surgery.
Structural Causes
Included in this category are deformities of the nose and the nasal
septum, which is the thin, flat cartilage and bone that separates
the nostrils and nose into its two sides. These deformities are
usually due to an injury
at some time in one's life. The injury may have been many years
earlier and may even have been in childhood and long since forgotten.
It
is a fact that 7 percent of newborn babies suffer significant nasal
injury just from
the birth process; and, of course, it is almost impossible to go
through life without getting hit on the nose at least once. Therefore,
deformities
of the nose and the deviated septum should be fairly common problems
-- and they are. If they create obstruction to breathing, they
can be corrected with surgery.
One of the most common causes for nasal obstruction in children
is enlargement of the adenoids: tonsil-like tissues that fill
the back of the nose up behind the palate. Children with this problem
breath noisily
at night and even snore. They also are chronic mouth breathers,
and they
develop a "sad" long face and sometimes dental deformities. Surgery to remove the adenoids and
sometimes the tonsils may be advisable.
Other causes in this category include nasal tumors and foreign
bodies. Children are prone to inserting various objects such
as peas, beans,
cherry pits, beads, buttons, safety pins, and bits of plastic
toys into their
noses. Beware of one-sided foul smelling discharge, which can
be caused by a foreign body. A physician should be consulted
Allergy
Hay fever, rose fever, grass fever, and "summertime colds" are various
names for allergic rhinitis. Allergy is an exaggerated inflammatory
response to a foreign substance which, in the case of a stuffy nose, is
usually a pollen, mold, animal dander, or some element in house dust.
Foods sometime play a role. Pollens cause problems in spring (trees)
and summer (grasses) or fall (weeds) whereas house dust allergies and
mold may be a year-around problem. Ideally the best treatment is
avoidance of these substances, but that is impractical in most cases.
> In the allergic patient, the release of histamine and similar substances
results in congestion and excess production of watery nasal
mucus. Antihistamine Help relieve the sneezing and runny nose of allergy. Many
antihistamines
are now available without a prescription. The most familiar
brands include
Chlor-Trimeton®, Benadryl®, or Dimetane® (although most are
also available in generic forms). Newer, nonsedating antihistamines, which require
a prescription
include Claritin®, Zyrtec®, and Allegra®. Decongestants shrink
congested nasal tissues. Examples include Sudafed®, Guaifed®, and Entex®
that
are
available without a prescription in several generic forms.
Combinations of antihistamines with decongestants are also available. All
these preparations have potential side effects, and patients must heed the
warnings of the
package or prescription insert. This is especially important
if
the patient suffers from high blood pressure, glaucoma, irregular heart
beats, difficulty
in urination, or is pregnant.
Allergy shots are the most specific treatment available, and
they are highly successful in allergic patients. Skin tests or at times
blood tests are used to make up treatment vials of substances
to
which the patient
is allergic. The physician determines the best concentration
for initiating the treatment. These treatments are given by injection.
They work by forming
blocking antibodies in the patient's blood stream, which then
interfere
with the allergic reaction. Many patients prefer allergy shots
over drugs because of the side effects of the drugs.
Patients with allergies have an increased tendency to develop
sinus infections and require treatment as discussed in the previous
section.
Vasomotor Rhinitis
''Rhinitis" means inflammation of the nose and nasal membranes.
"Vasomotor" means blood vessel forces. The membranes of the nose have
an abundant supply of arteries, veins, and capillaries, which have a
great capacity for both expansion and constriction. Normally these
blood vessels are in a half-constricted, half-open state. But when a
person exercises vigorously, his/her hormones of stimulation (i.e.,
adrenaline) increase. The adrenaline causes constriction or squeezing
of the nasal membranes so that the air passages open up and the person
breathes more freely.
The opposite takes place when an allergic attack or a ''cold''
develops: The blood vessels expand, the membranes become congested
(full of
excess blood), and the nose becomes stuffy, or blocked.
In addition to allergies and infections, other events can also
cause nasal blood vessels to expand, leading to vasomotor
rhinitis. These include psychological stress, inadequate thyroid function,
pregnancy, certain
anti-high
blood pressure drugs, and overuse or prolonged use of decongesting
nasal sprays and irritants such as perfumes and tobacco
smoke.
In the early stages of each of these disorders, the nasal
stuffiness is temporary and reversible. That is, it will
improve if the
primary cause is corrected. However, if the condition
persists for a long
enough period,
the blood vessels lose their capacity to constrict. They
become somewhat like varicose veins. They fill up when
the patient lies
down and
when he/she lies on one side, the lower side becomes
congested. The congestion often
interferes with sleep. So it is helpful for stuffy patients
to sleep with the head of the bed elevated two to four
inches accomplish
this by
placing
a brick or two under each castor of the bedposts at the
head of the bed. Surgery my offer dramatic and long time
relief.
Summary
Stuffy nose is one symptom caused by a remarkable array
of different disorders, and the physician with special
interest in nasal disorders
will offer treatments based on the specific causes.
©2002 American Academy of Otolaryngology-Head and Neck
Surgery One Prince St., Alexandria, VA 22314-3357,     1-703-836-4444
Hay fever describes the symptoms of runny nose, itchy eyes and throat,
uncontrollable sneezing and sometimes itching of the skin. It is
not caused by hay, and does not produce fever. The correct name for the
condition
is seasonal allergic rhinitis.
Many seasonal "colds" are actually allergic rhinitis and will hot respond to antibiotics. Seasonal
allergic rhinitis happens when pollens and/or particles of plant
or animal dander, mold spores, etc., come into contact with the lining
of the nose,
eyes, or throat. The body's immune system recognizes their presence
and starts a reaction to prevent their invasion. In most people this is
not
a problem. However, in some patients the immune system is overactive
and identifies normally harmless particles as dangerous, producing an
excessive
reaction that actually causes inflammation. This is known as allergy
and the substances causing it are allergens. People are allergic to only
certain
substances, and the reaction does not usually appear until after
several exposures to that substance.
The Causes
Hay fever is caused by pollens,
the most significant in the United States is from ragweed. It begins
pollinating in late August and continues until the first frost.
Pollen Allergens
Late springtime pollens come from the grasses, i.e. timothy, orchard,
red top, sweet vernal, Bermuda, Johnson, and some bluegrasses
Early springtime hay fever is most often caused by pollens of trees such as elm,
maple, birch, poplar, beech, ash, oak, walnut, sycamore, cypress, hickory,
pecan, cottonwood, and alder.
Colorful or fragrant flowering plants rarely cause allergy because their pollens
are too heavy to be airborne.
Certain allergens are always present. These include house dust, household pet
danders, foods, wool, various chemicals used around the house, and more.
Symptoms from these are frequently worse in the winter when the house is
closed up. Mold spores cause at least as many allergy problems as pollens.
Molds are present all year long, and grow outdoors and indoors. Dead leaves
and farm areas are common sources for outdoor molds. Indoor plants, old
books, bathrooms, and damp areas are common sources of indoor mold growth.
Molds are also common in foods, such as cheese and fermented beverages.
Can Allergies Be Serious?
Allergic patients show reduced resistance to respiratory infections, and more
severe symptoms when infections occur. Allergies are rarely life threatening,
but often cause lost work days, decreased work efficiency, poor school
performance, and a negative effect on the enjoyment of life. Considering
the millions spent in anti-allergy medications and the cost of lost work
time, allergies cannot be considered a minor problem.
Why See a Doctor?
The ENT specialist (otolaryngologist) will do a complete examination
of your ears, nose, throat, head and neck. Careful evaluation of the
sinuses will enable him to determine if infection or structural abnormality
(deviated septum, polyps) are contributing to your symptoms.
Treatment
A number of medications are useful
in the treatment of allergy including antihistamines, decongestants,
cromolyn, and cortisone-type preparations. The medical management of
allergy also includes counseling in proper environmental control. Based
on a detailed history and thorough examination, your doctor may advise
testing to determine the specific substances to which you are allergic.
The methods employed by your otolaryngologists will indicate the
materials to which you are allergic, and the degree of your sensitivity
to them. The only "cure" available for inhalant allergy is the
administration of injections that build up protective antibodies to
specific allergens (pollens, molds, animal danders, dust, etc.). Your
physician will oversee your progress throughout the course of treatment
and care for any other nasal and sinus disorders that may contribute to
your symptoms.
Prevention Tips
* Wear a pollen mask when mowing grass or house cleaning (most drugstores sell
them).
* Change the air filters monthly in heating and air conditioning systems, and/or
install an air purifier.
* Keep windows and doors closed during heavy pollination seasons.
* Rid the home of indoor plants and other sources of mildew.
* Don't allow dander producing animals (i.e. cats, dogs, etc.) in the home.
* Change feather pillows, woolen blankets, and woolen clothing to cotton or synthetic
materials.
* Enclose mattress, box springs and pillows in plastic barrier cloth.
* Use antihistamines and decongestants as necessary and as tolerated.
* Sleep with the head of the bed tilted upwards. A brick or two placed under
bedposts at the head of the bed helps relieve nasal congestion.
* Observe general good health practices; exercise daily, stop smoking, avoid
other air pollutants, eat a balanced diet, and supplement diet with vitamins,
especially C.
* Consider a humidifier in the winter as dry, indoor heat aggravates many allergic
people, but beware of possible mold growth in the humidifier.
* Discuss hay fever and allergy symptoms with your physician when you experience
an allergic reaction.
© 2001 AAO-HNS, Inc.
You don't have a cold or allergy–you have a sinus condition. What does that mean?
An
ear, nose, and throat specialist will determine if your sinus pain
results from:
Allergic rhinitis: This condition is an inflammatory nasal response,
most commonly to inhalant allergens. Symptoms include sneezing
and itchy eyes, nose, and palate. Allergic rhinitis can induce sufficient
inflammation
to obstruct the openings to the sinuses. Consequently, the sinuses
become infected and a bacterial sinus infection occurs.
Infectious sinusitis: When chronic, this bacterial disease produces
nasal secretions that are yellow and green and contain bacteria.
Patients may feel pain and pressure in the involved sinuses and
may be ill with
fever, malaise, and other symptoms. The classic symptoms of this
condition are nasal obstruction, congestion, facial pain, and
post-nasal drip.
Septal deviation: A nose that is not properly aligned may result
in an airway obstruction, thereby causing sinus problems. Standard
surgical or medical treatments for sinusitis will not aid in
treating sinus pain
resulting from this condition.
Other causes of sinus pain include:
Vasomotor rhinitis: This disorder is caused by stress or a psychological
disorder, manifesting as congestion, obstruction, sinus pain,
and nasal secretion. Unlike other sinus disorders, this condition
“comes and goes,”
presenting itself episodically with stress.
Nasal polyps: Nasal polyps are a consequence of inflammation
that results from a wide range of sinus disorders. Treatment
should entail addressing the root causes of the polyps as
well as excising
the
growths.
Fungal sinusitis: An allergic response to fungi can result
in chronic sinusitis. This condition affects approximately
seven percent
of
those suffering from chronic sinusitis.
Aging rhinitis: As one ages, the nasal mucus loses its
water content and becomes increasingly thick and sticky.
Patients complain of
post-nasal drip, cough, and hoarseness; the condition
is best treated with nasal irrigation
and increased hydration.
Tumors: The presence of tumors in the sinuses is relatively
uncommon. They are discovered with a nasal obstruction,
often with heavy
nosebleeds.
© 2001 AAO-HNS, Inc
Sinus Pain: Can Over-the-Counter Medications Help?
Why do we suffer from nasal and sinus discomfort?
* The body’s nasal and sinus membranes have similar responses to viruses, allergic
insults, and common bacterial infections. Membranes become swollen and congested.
This congestion causes pain and pressure; mucus production increases during
inflammation, resulting in a drippy, runny nose. These secretions may thicken
over time, may
slow in their drainage, and may predispose to future bacterial infection of
the sinuses.
Congestion of the nasal membranes may even block the eustachian
tube leading to the ear, resulting in a feeling of blockage
in the ear or fluid behind the
eardrum. Additionally, nasal airway congestion causes the individual to
breathe through the mouth.
Each year, more than 37 million Americans suffer from sinusitis, which
typically includes nasal congestion, thick yellow-green nasal discharge,
facial pain
and pressure. Many do not understand the nature of their illness or what
produces
their symptoms. Consequently, before visiting a physician, they seek
relief for their nasal and sinus discomfort by taking non-prescription
or over-the-counter
(OTC) medications.
What is the role of OTC medication?
* There are many different OTC medications available to relieve
the common complaints of sinus pain and pressure, allergy problems, and
nasal congestion.
Most of these
medications are combination products that associate either a pain reliever
such as acetaminophen with a decongestant or an antihistamine. Knowledge
of these
products and of the probable cause of symptoms will help the consumer
to decide which product is best suited to relieve the common symptoms
associated
with nasal
or sinus inflammation.
OTC nasal medications are designed to reduce symptoms produced
by the inflammation of nasal membranes and sinuses. The goals of OTC
medications
are to: (1)
reopen to nasal passages; (2) reduce nasal congestion; (3) relieve
pain and pressure
symptoms; and (4) reduce potential for complications. The medications
come in several forms.
Nasal saline sprays: non-medicated nasal sprays
* Nasal saline is an invaluable addition to the list of over-the-counter
medications. It is ideal for all types of nasal problems. The added
moisture produced by the
saline reduces thick secretions and assists in the removal of infectious
agents. There is no risk of becoming “addicted” to nasal saline.
It should be applied
as a mist to the nose up to six times per day. Nasal saline can
also be made at home: use one cup of boiled water and ¼ tsp. of
non-iodized salt
with
or without ¼ tsp. of baking soda.
Nasal decongestant sprays: medicated nasal sprays
* Afrin nasal spray, Neo-Synephrine, Otrivin, Dristan nasal spray,
and other brands decongest the swollen nasal membranes. They
clear nasal
passages almost
immediately and are useful in treating the initial stages of
a common cold or viral infection. Nasal decongestant sprays are
safe to use,
especially appropriate
for preventing eustachian tube problems when flying, and to halt
progression of sinus infections following colds. However, they
should only be utilized
for 3-5 days because prolonged use leads to rebound congestion
or “getting hooked
on nasal sprays.” The patient with nasal swelling caused by seasonal
allergy
problems should use a cromolyn sodium nasal spray. The spray
must be used frequently (four times a day) during allergy season
to prevent the release
of histamine
from the tissues, which starts the allergic reaction. It works
best before symptoms become established by stabilizing the nasal
membranes
and has
few side effects.
Decongestant medications
* Pressure and congestion are common symptoms of nasal passage
swelling. Decongestant medications are OTC products that relieve
nasal swelling,
pressure, and congestion
but do not treat the cause of the inflammation. They reduce blood
flow to the nasal membranes leading to improved airflow, less
breathing through the
mouth,
decreased pressure in the sinuses and head, and subsequently
less discomfort.
Decongestants do not relieve drippy noses. Their side effects
may include light headedness or giddiness and increased blood
pressure
and heart
rate. (Patients
with high blood pressure or heart problems should consult a physician
before use.) In addition, other medications may interact with
oral decongestants causing side effects. The most common decongestants
are pseudoephedrine
(Sudafed) and
phenylpropanolamine. Both of these are available as single products
or in combination with a pain reliever or an antihistamine. They
are labeled
as
“non-drowsy” due
to a side effect of stimulation of the nervous system.
Decongestant-combination products
* Some medications are combined to reduce the number of pills.
Tylenol–Sinus or Advil Cold and Sinus exemplify products that
join a pain reliever
(acetaminophen or ibuprophen) with a decongestant (pseudoephedrine).
These products relieve
both sinus and cold/flu symptoms yet retain all the attributes
of the individual drug including side effects.
Antihistamine medications
* Antihistamines combat allergic problems leading to nasal
congestion. OTC antihistamines such as diphenhydramine (Benadryl),
or clemastine
(Tavist) may be used for relieving
allergic symptoms of itching, sneezing, and nasal congestion.
They relieve the drainage associated with the allergic inflammation
but not obstruction
or congestion.
Antihistamines have a potential for sedation causing grogginess
and dryness after use. Newer nonsedating antihistamines are
available.
Antihistamine-decongestant combination products
* Antihistamines and decongestant products are often combined
to relieve multiple symptoms of congestion and drainage
and reduce the side effects
of both products.
Antihistamines produce sedation; decongestants are added
to make them “non-drowsy.” The combined allergy product
then relieves
congestion
and a runny nose.
© 2001 AAO-HNS, Inc.
An otolaryngologist—head and neck surgeon will, for the most part, advocate surgery
when antibiotics and other medical treatments fail to alleviate chronic
sinusitis or multiple episodes of acute sinus infection. Before considering
surgery, the otolaryngologist will typically prescribe four to six weeks
of antibiotics plus sprays, decongestants, and possibly antihistamines
and steroids.
Surgery for Acute Sinusitis
Antibiotics are generally effective for most cases of acute sinusitis
resulting in severe facial pain and pressure. Other treatments for
lingering symptoms include sinus irrigation, which requires the placement
of an instrument in the maxillary sinus to flush out that cavity
with salt water.
Two types of acute sinus infection require special attention from
a specialist. A severe infection of the frontal (forehead) or sphenoid
sinus (behind the eyes) can be very serious. If oral or intravenous
antibiotics are not effective, surgical drainage of the sinus may
be undertaken. The sphenoid sinus can be accessed surgically through
the nose or through an incision under the eyebrow. The latter procedure
requires hospitalization.
Surgery for Chronic Sinusitis
Most surgeries on the sinuses are conducted to relieve a chronic
condition. In the past, operations on the sinuses were conducted
externally through incisions on the face. Incisions were made under
the upper lip through the gum (the Caldwell-Luc operation) or an
external ethmoidectomy, a removal of the sinuses between the eyes
through an incision in the face. However, most surgical procedures
for the sinuses are now carried out using endoscopic sinus surgery.
Endoscopic Sinus Surgery
Twenty years ago, otolaryngologist —head and neck surgeons would
perform surgery on the individual sinuses that had become infected,
leading to the use of procedures such as the Caldwell-Luc operation.
Since then, the development of endoscopic sinus surgery (ESS)
ushered in a new philosophy allowing the surgeon to target the
ostiomeatal
complex (OMC), an area in the anterior ethmoid sinus region.
Obstruction in the OMC can lead to subsequent infection of the
maxillary, frontal,
and sphenoid sinuses. Accordingly, endoscopic sinus surgery,
a procedure through the nose, removes thickened and diseased
tissue
that blocks
the OMC. Most of the healthy tissue in the sinuses is undisturbed
allowing rapid recovery.
Endoscopic surgery can also be utilized for removal of polyps
and to straighten the septum thus restoring a normal flow from
the
sinuses. Unlike other sinus surgical procedures, endoscopic sinus
surgery
has minimal and usually temporary effect on the patient's appearance.
What to expect from endoscopic surgery
The endoscopic procedure usually lasts from one to three hours
and is performed using general or local anesthesia. Generally,
the patient
goes home after surgery unless other medical conditions complicate
recovery.
Full recovery may take several weeks. Dry blood, mucus, and
crusting in the nose may occur, presenting symptoms of a severe
cold or
sinus infection. Nasal irrigation or salt-water sprays and
antibiotic lubricants
as recommended by the surgeon to facilitate normal sinus activity.
Proper post-operative care is essential to prevent scar formation
and allow normal healing. The surgeon performing the procedure
will generally perform all required follow-up procedures.
Patients who depend on their voice for their livelihood should
be warned that endoscopic sinus surgery may have an effect
on their resonance. Additionally, some patients may have underlying
nasal
mucosal problems that remain after surgery. This is seen in
highly
allergic individuals or asthmatics.
© 2001 AAO-HNS, Inc. |
