What is causing your nasal congestion?

What is causing that congestion in my nose ? It’s the middle of winter in central Texas and you have persistent nasal congestion. You must have the dreaded Cedar allergies… Or maybe you have a viral upper respiratory infection… Or maybe you have a sinus infection…Or maybe you have undiagnosed chronic sinusitis. How do we know what to treat? It’s a confusing time of year with multiple different etiologies for nasal complaints. Cedar, mold, and very soon oak allergies, will cause patients with sensitivity to have increased clear nasal congestion, sneezing, and itchy/watery eyes. Typically there will be no evidence of fever or other signs of significant illness. Most patients will gain significant benefit by taking an over-the-counter antihistamine and nasal steroid. The most common time to catch a cold is also this time of year. A viral upper respiratory infection presents with nasal congestion, sinus pressure, mild fatigue, cough and possible fever. The nasal congestion typically remains clear. Treatment is symptomatic with NSAIDs, decongestants, expectorants, and over-the-counter cough medications. Symptoms typically start to abate after 5 to 7 days. Some patients develop significant nasal inflammation when their allergies act up. This can lead to a sinus infection. Some patients that have a viral URI can progress into a bacterial sinus infection instead of spontaneously clearing the virus. Typically a bacterial sinus infection will present with more copious colored nasal discharge. Facial fullness and fatigue can be significant. Fever is not always present with a bacterial sinus infection. These patients are best treated with a short course of antibiotic to eradicate the bacteria. Finally, some patients may note issues with any of the above diagnoses, but never seem to get complete resolution of symptoms between episodes. These patients often times have chronic sinusitis. Chronic sinusitis is a persistent inflammation of the sinus linings. These patients note mild chronic congestion, nasal obstruction, and facial fullness. They are best treated with aggressive medical therapy to include antibiotics, oral steroids, and allergy medications if they have allergies. Unfortunately some patients will continue to have problems and benefit from simple sinus interventions such as balloon Sinuplasty. Balloon Sinuplasty is a simple clinic procedure that dilates blocked sinus drainage pathways to alleviate sinus pressure, congestion, and infection. If you are having difficulty trying to decide what is causing your wintertime nasal congestion, an otolaryngologist has the tools to make a definitive diagnosis and help you toward a permanent resolution Zachary Wassmuth, MD