Decongestants cause constriction of the blood vessels in swollen mucous membranes, forcing blood out so that the membranes shrink and air passages open. Decongestants are chemically related to adrenaline, a natural decongestant that is also a stimulant. Decongestants should not be used by patients who have an irregular pulse, high blood pressure, heart disease or glaucoma. Also, certain decongestant drugs such as pseudo-ephredine should not be used by patients who suffer from benign prostate hyperplasia because the drug can aggravate prostate enlargement.

There are a variety of decongestant nasal sprays available over the counter. These medicines can produce significant temporary symptomatic relief of nasal obstruction, however, they can also become addictive as rebound nasal congestion occurs with overuse.

Several corticosteroid therapies, most in the form of a nasal spray or inhaler, have been developed to treat chronic nasal obstruction. Intranasal corticosteroids are available only by prescription and they can be very effective, however, they are associated with side effects such as bleeding, drying and crusting.

Patients must take care not to overuse corticosteroid preparations. Although the drugs are applied topically, some systemic absorption of the agent occurs, which can disrupt the body's steroid balance. Steroids can also be injected directly into the turbinates, however, their effectiveness lasts only three to six weeks.

Intranasal cromolyn is another type of drug therapy; it is a preventive medication and can be very effective in preventing a hypersensitivity allergic reaction in the turbinates (but only if used before exposure to irritants. Although side effects are unusual, cromolyn can produce nasal burning, headaches and sneezing.

In severe cases of allergic rhinitis, immunotherapy (allergy shots) may be recommended. With immunotherapy, a patient is injected with increasingly larger amounts of an allergen to encourage the body to build up resistance. While modestly effective in selected patients, immunotherapy can be a lengthy and expensive process.

Cautery (burning) of enlarged turbinates can be done with an electrosurgical probe or a laser and is usually performed as an office procedure. Both electrocautery and laser surgery are performed on either the surface of the turbinate tissue or sub-mucosally.

Surface cautery results in edema and crusting in the nose which can last three weeks or longer, while sub-mucosal cautery can cause swelling for up to 10 days. Another method for improving nasal obstruction is outward fracture of the turbinate bone(s), which moves the turbinate away from its obstructive position in the airway. This approach, however, does not address the usual source of obstruction---enlarged sub-mucosal tissue, and the fractured turbinate often returns to its previous position.

Turbinate resection (removal of the bone and/or soft tissue) and excision (removal of the soft tissue only) can be performed with surgical scissors or a laser. Physicians can reduce nasal obstruction by cutting away excess tissue from the surface of the turbinate with angled scissors. Following treatment, the nose must be packed for several days with gauze containing an antibiotic ointment.

Bleeding, which can usually be managed by packing the nose, is the greatest risk for patients undergoing standard turbinate resection. Over-resection of the turbinates has been reported as the cause of excessive, irreversible drying of the turbinates. Resection, excision and surface cautery can all be associated with prolonged crusting and healing, which occurs over a four-to-six-week period.

Laser resection of the turbinates uses light energy that reaches temperatures of 750°C to 900°C(1,400°F to 1,700°F) to vaporize the turbinate mucosa. Safety issues related to the use of the laser require special precautions and physicians must take special care to avoid burning the nasal septum and face. The crusting and bleeding rates with laser surgery are similar to cautery procedures.

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