What Causes Nasal Congestion?

Nasal congestion is usually caused by underlying anatomic abnormalities of the nose and/or inflammation and swelling of the lining of the nose called the “mucosa.”

The inside of the nose contains the septum that divides the left and the right side. This is made of bone and cartilage and covered by mucosa. Most people have some degree of “septal deviation.” This means that the septum is crooked to one side or the other. It can sometimes be deviated to both sides in different places. When there is a significant deviation, there can be blockage on one side of the nose and sometimes both. You can be born with the deviation or this could have been acquired through trauma to the nose.

deviated septum illustration

On each side of the nasal cavities you have turbinates. These bony protuberances project into the airway to help the flow of air. They increase the surface area to allow for warming, humidification, and filtration of the air we breathe.

The mucosa lines the septum and turbinates and produces mucous that coats all of the internal nasal surfaces. The mucous helps to trap and filter particles we breathe in. It also provides moisture and humidity. The mucosa contain tiny specialized cells that have microscopic hairs that sweep mucous to the back of the nose and eventually down into the throat where it is swallowed. This is a process that normally you don’t notice. When there is increased mucous, you may notice this as postnasal drip.
Underneath the mucosa, vascular tissue called submucosa help with warming the air we breathe. When there is increased inflammation due to infections such as the common cold or allergy, the mucosa and submucosa swell causing the nose to feel blocked. There is also increased mucous production resulting in a runny nose or postnasal drip. If there are severe allergies the mucosa and submucosa can swell significantly over time and form polyps that can lead to even more nasal congestion.

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