Not all congestion is Allergies

Look at any list of allergy capitals the US, and Texas will always be well represented. Surprisingly, not all nasal congestion is caused by seasonal allergies. More than half of the patients that I treat with self-diagnosed allergies actually have another diagnosis causing their nasal complaints. Most patients with typical seasonal allergies will have absolutely no nasal complaints except when their particular allergen is present. Cedar, which is pollinating now, is probably one of the worst central Texas allergens. Most patients will complain of itchy eyes, watery eyes, sneezing, clear nasal congestion, and nasal obstruction from nasal inflammation. When cedar season is over, patients with cedar allergies should have complete resolution of their symptoms. Many patients complain of nasal and sinus symptoms year-round. It is still possible that allergies to mold and dust will give the symptoms, but more commonly it is for other reasons. Patients who have unilateral nasal obstruction year-round most frequently have a nasal septal deviation which can be resolved with a simple 20 minute procedure. Patients with year-round congestion and postnasal drainage more frequently have chronic sinonasal inflammation or infection that has been undiagnosed. The correct diagnosis and proper medical therapy or balloon Sinuplasty will typically resolve these problems. Many adults will become “addicted” to topical nasal decongestants. These medications decongest the nasal turbinates, but over time have the opposite effect. Turbinate enlargement for any reason, to include allergies, can be resolved with a brief clinic procedure allowing patients to stop using oral and topical decongestants altogether as well as decrease allergy medication use. Patients that snore and have mouth breathing at night often have one or more of the above problems. Children most commonly have adenoid enlargement at the back of the nose which causes nasal obstruction, congestion, and loud breathing or restless sleep. If your child is “not responding” to allergy medications, she probably does not have allergies. Adenoidectomy will allow your child to breathe easy and sleep sound. Even if you have had positive allergy testing, a brief visit with the otolaryngologist will often times uncover diagnoses that can be permanently corrected with simple procedures alleviating long-term nasal congestion and nasal obstruction complaints. Zachary Wassmuth, MD