Q: I am 27 years old. The right side of my nose stays blocked most of the time, due to which I feel that less oxygen is reaching my brain. I am not able to concentrate on work. My head gets very heavy and at times my brain doesn't work. I had undergone a minor nose surgery to create more space in my right nasal passage few years back. It was OK for sometime but the problem has come back. I have a very flexible nose, it can be twisted easily. When I sleep towards either side, my nose goes down in the same direction. I have a puffy face in the morning when I get up and do not have a fresh mind. Due to this I find it difficult to remember things. I stay depressed and my career is being greatly affected. Please advise.

A:Nasal blockage can result from the swelling of the lining (mucosa) of the nose or an anatomical (structural) blockage due to a deformity of the cartilaginous or bony structures of the nose. Normally, there is a nasal cycle in which there is alternate congestion (swelling) and decongestion (shrinkage) of the nasal mucosa of each nostril due cyclical engorgement of the mucosal blood vessels. Thus, one can notice alternate blocking of the nostrils and this is most pronounced while lying down and a person alternates sides while sleeping. This cycle lasts for several hours but has individual variation Several factors affect it including posture (while lying on the side, the nostril that is on top becomes more open), emotional excitement (which causes nerves inside the nose to make the lining swell) etc. The common causes for mucosal swelling are common cold, chronic sinusitis, nasal allergy (sensitivity to dust, smoke, pollution and other irritants), nasal drop overuse, side effect of medications while anatomical causes include deviated nasal septum, nasal polyps, large adenoids, a foreign body in the nose or hypertrophy of the turbinates. Anatomic causes usually lead to breathing from one side only, the problem persists for months and there may be accompanying snoring and frequent sinus infection. As you have already undergone surgery and the problem still persists, it is likely that non-anatomical factor(s) are causing the problem and not a structural defect. Please consult an experienced ENT specialist who can examine you and advise appropriately.