What is Congestion?

[Ryan Neely]

This seems like a stupid question, and I promise I'm not purposefully being obtuse, but what does it mean to you to "be congested?"

Here's some background. I have seasonal allergies. They've been a serious consideration for every aspect of my life. As a youth, I was half-blind for three days thanks to an over-excited cottonwood (for example).

I think, due to these allergies, my body seems to produce copious amounts of phlegm. (Note: I have not scientific data to back up this hypothesis.) Not to be terribly uncouth, but I have considered the constant nasal drainage, the never-ending sniffle, and the every-present throat-clearing as a family trait. (My father sniffles and snorts. My grandfather is never without a hankie in his hand or a lugie flying from his mouth.) There have often been times when medical professionals have had to irrigate my ears, extracting pencil-eraser-sized packets of wax.

I go into this kind of detail because ... I would consider this to be congestion. (Thanks to four years of allergy shots, however, these symptoms have been dwindling with rapid speed.) However, when discussing my concerns of "chronic congestion" in relation to scuba, I am essentially told it's not an issue.

Indeed, it hasn't been an issue ... thus far. To be fair, my max depth to date has only been forty feet, but equalizing has been easy and simple, and I've not experienced any discomfort of pain.

This leads me to wonder if the symptoms I consider "chronic congestion" is, in fact, nothing more than what other people experience every day as well. (In other words, perhaps I'm not a special snowflake. Perhaps my experience is, in fact, quite elementary.)

So, let me ask, what symptoms do you consider to be "congestion?"

 

[RyanT]

Congestion is inflammation of the mucus membranes that can line a variety of airways in the sinuses, eustanian tubes, nasal cavity, etc. This inflammation tends to close off these passages. Having a runny nose, eyes, mucus production can occur from the over production of histamines that dilate blood vessels in these same spaces and activate the mucus producing cells. The runny nose and mucus production often accompanies congestion and/or can make it worse, but they are not necessarily the same thing.

As you've experienced, you can have the runny nose and mucus production without the inflammation that closes off your eustachian tubes. Just make sure your ears equalize easily on descent and you should be fine.

@Duke Dive Medicine and @doctormike, please correct me if I'm wrong on this.

 

[doctormike]

Well, "congestion" is one of those inexact non-medical terms that is commonly used by different people to mean different things (like SAC rate!). Basically, there are three processes that a person with allergies or an upper respiratory tract infection might experience in their upper airway mucosa.

One is an actual swelling of the soft tissues, which would cause nasal obstruction (and possibly poor ventilation of the middle ears and sinuses, as the lining of their drainage pathways also will swell). This can be from vascular engorgement (extra blood going into the blood vessels in, say, the nasal turbinates) or from interstitial fluid (a leakage of fluid out of the bloodstream into the spaces between cells, often caused by inflammation). Some patients with chronic sinusitis will develop nasal polyps, which you can think of as permanently swollen lining of the nose which becomes and actual obstructing mass - these are sometimes removed surgically.

The second is an overproduction of mucus, which comes from specialized glands lining the airway. You could have this without the swelling, so your nose would be watery but you wouldn't have any problem breathing. Mucus is a normal and important bodily secretion, it helps keep the airway clean. But an overproduction can be uncomfortable, and may happen with allergies, in response to irritants (like cigarette smoke) or with upper airway infections.

The third would be an actual bacterial infection in the sinuses, which could cause pus to develop in those spaces and then spill out into the nasal airway.

A "runny nose" could be a combination of #2 and #3. What we think of as "snot" is really dried mucus when it turns from liquid to solid, since the nose is one of the few places in the upper airway that isn't always humid. That's why we get nosebleeds, and why rebreathers are so great (yay, warm humid air!).

So to answer the OP, if you can equalize, you can equalize, and it sounds as if you have more of an overproduction of mucus than an actual blockage of the nasal airway, the paranasal sinus outflow tracts, and the Eustachian tubes...

 

[Ryan Neely]

Perfect. Thanks, Mike!