Nasal Congestion or Obstruction During Pregnancy

When a woman becomes pregnant, it is not unusual for the nose to become quite congested... uncomfortably so, even to the point of being unable to breath through the nose.

This condition known as "rhinitis of pregnancy" affects as many as 30% of pregnant women and can start in the second month of pregnancy; it tends to worsen later in pregnancy. The nasal congestion should ease up soon after giving birth and be gone completely within two weeks after delivery.

The nasal congestion occurs due to elevated amounts of estrogen causing swelling of nasal mucous membranes. Furthermore, there is a marked increased in circulating blood in the body which also leads to swelling of the tiny blood vessels lining the nose. Bloodflow causing nasal obstruction (turbinate hypertrophy) is not unusual and even occurs in men (laying down on one side causes nasal obstruction that than switches when laying down on the other side; improves when sitting/standing).

On exam, a common finding are large inferior turbinates. Inferior turbinates are soft tissue outpouchings within the nose that warm and humidify the air as nasal breathing occurs. Normally, they are quite small, but with rhinitis of pregnancy, they can become enormous... even quadrupling in size.

Inferior Turbinates Seen on Exam

Generally speaking, my approach to treating this uncomfortable condition is as follows (assuming all other causes are ruled out and no medical contraindications):

1) Regular HYPER-tonic saltwater nasal irrigations to the nose 3-4x per day. I recommend HYPER-tonic saltwater rather than regular strength saltwater. Why? Salt sucks moisture out of the nose. With regular strength saltwater (aka, normal saline), the saltwater concentration is equal to that found within the body and minimal if any moisture displacement (osmosis) occurs. With HYPER-tonic saltwater, given the increased salt concentration compared to that found within the body, moisture leaves the nose allowing for decongestion to occur.

Nasal irrigations can be performed with Neti Potor NeilMed Sinus Rinse Bottle. Hypertonic salt packetscan be purchased and mixed with 8 ounces distilled water. Or, if you want to make it yourself, 1/2 to 3/4 teaspoon of salt and 1/4 teaspoon of baking soda in 8 ounces of distilled water.

2) Rhinocort AQ (prescription) steroid nasal spray 2 sprays on each side daily. Steroids help to decrease swelling, especially the large inferior turbinates. This steroid nasal spray is the ONLY steroid nasal spray that is Class B for pregnancy.

3) Keep the head elevated when you lie down. This reduces the blood flow to the nose which exacerbates the nasal congestion.

Of course, steps 1 and 2 assume that there is SOME room for the treatment to occur. If the nose is 100% blocked up, use over-the-counter Afrinnasal spray a few times to get things to open up. Once opened up some, immediately start #1 and 2. It is not healthy nor wise to use afrin too much. Ideally, it may need to be used for only 1 day and no more thereafter. Even in non-pregnant individuals, afrin should never be used more than a few consecutive days otherwise risk addiction!

Response to treatment typically occurs within 2 weeks.

The Doctors TV Show Does Adenoidectomy

Dr. Nina Shapiro was the featured otolaryngologist when The Doctors television show discussed nasal congestion as well as large adenoids. A sanitized view of adenoid removal surgery was also shown.

For a more detailed view of the surgery, click here.

For more info on adenoids and its surgical removal, click here.

Nasal Congestion Affected By How Well the Nose is Able to Cool Itself

Researchers at Monell Chemical Senses Center have figured out that nasal congestion is influenced by more than just nasal airflow. Apparently temperature and humidity influence the perception of nasal congestion just as much as how physically obstructed the nose is.

By having volunteers breath air with variations in temperature and humidity, they have determined that cool and dry air minimizes nasal congestion without any change in how open the nasal cavity is.

By taking into account other measured variables, they have deduced that nasal congestion is influenced by how well the nose is able to cool itself from the nasal airflow specifically. The more warm and humid the air is, the less able the nose is able to cool itself leading to perception of nasal congestion.

With actual nasal obstruction, it may be not so much that you can't breath that causes the feeling of nasal congestion, but rather the reduced ability of the nose to cool itself from the absence/reduction of air circulation within the nasal cavity.

So... if nasal cooling influences perception of nasal congestion, this may be one of many factors that may help explain the phenomenon of Empty Nose Syndrome. Patients suffering from Empty Nose Syndrome have an abnormally open nasal cavity from extensive surgical removal of internal nasal structures... yet complain the most bitterly about how congested their nose feels.

This information may also help guide treatment in patients with tracheostomy who also have a totally open nose, but because they breath thru an opening in the neck, have no nasal airflow in the nose which leads to the sense of nasal congestion.

Based on this new research, in these particular patient populations, providing allergy medications like steroid nasal sprays and anti-histamines may not be the best way of addressing nasal congestion.

Clearly, more research is needed on this topic, but certainly opens other new avenues of possible treatment protocols.


Reference:
Perceiving Nasal Patency through Mucosal Cooling Rather than Air Temperature or Nasal Resistance. PLoS ONE 6(10): e24618. doi:10.1371/journal.pone.0024618