Subjective Nasal Fullness and Objective Congestion

Abstract

How well do subjective descriptions of the sensation of nasal closure or absence of nasal patency agree with objective measures of nasal geometry and airflow? Problems with this concept begin with terminology. ''Congestion'' has been applied to both the subjective and objective measures. Therefore, the term ''fullness'' will be used to describe perceptions of nasal mucosal heaviness or blockage that subjects with allergic rhinitis articulate. ''Congestion'' will refer to the objective measures used to assess patency. Sensations attributed to the nasal mucosa are highly integrated interpretations summed from multiple subsets of nociceptive and other neurons. Activation of sensor systems is required to depolarize afferent neurons. These sensors and other receptor proteins can be modulated by inflammation as part of the neural plasticity that leads to increased sensitivity to nasal stimuli. This plasticity and hyperalgesia may extend from the afferent neuron to spinal cord dorsal horn synapses, and regulatory and analytical regions of the brainstem and cerebrum. Although glandular hypersecretion can deliver obstructing material into the nasal cavities, the dilation of deep venous sinusoids is the strongest factor regulating nasal airspace volumes. There is a long history of attempts to correlate subjective sensations to objective measurements such as airflow resistance (rhinomanometry), nasal wall geometry (acoustic rhinometry), and peak nasal inspiratory flow. The medical evidence supporting each method has been analyzed on the basis of the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system. These results provide a starting point for linking the outcomes of pathophysiological processes with a patient's psychometrically calibrated sensation of airflow.

A Single-centre, Before-After Study of the Short- and Long-term Efficacy of Narivent® in the Treatment of Nasal Congestion

“…14 -16 Subjective changes in perceived congestion severity can be assessed using a visual analogue scale (VAS) or one of a number of symptom-scoring systems including ordinal scales and questionnaires such as the RhinoSinusitis Outcome Measurement, the SinoNasal Assessment Questionnaire, the Congestion Quantifier five-item test for nasal congestion and the SinoNasal Outcome Test-22. 9 Therapeutic intervention is aimed at relieving subjective complaints and, as such, measurement of subjective parameters is necessary. 14 The VAS offers a reproducible, quantifiable evaluation of patients' symptoms, which may provide more subtle information than simply asking whether the patient is better, the same, or worse.…”

Empty nose syndrome

“…The paradoxical nasal obstruction is the most common complaint, a subjective feeling of nasal "stuffiness"; during physical examination of the nasal fossae, the permeability of the nasal fossae is noted because of the nasal conchae tissue absence 12 . The feeling of nasal obstruction may be associated with the feeling of ''emptiness'', patients refering to this term to depict the subjective incapacity to perceive the airflow, mainly noted due to total inferior turbinectomy.…”

Empty nose syndrome: A literature review

“…Данный процесс активирует TRPM8, передающие информацию в респираторный центр головного мозга, что приводит к расслаблению дыхательной мускулатуры [17,18]. Вдыхаемый воздух стимулиру-ет рецепторы растяжения бронхов, передавая сиг-нал о насыщении легких кислородом в центральную нервную систему благодаря носолегочному рефлек-су [19].…”