Chronic Nasal Congestion: Symptoms, Causes, Treatment

Blockage may alternate sides, affect both sides or remain on one side. It can disturb sleep, smell and breathing. It does not automatically indicate bacterial sinusitis or a need for antibiotics.

Related reading: Taste changes and their relationship to smell.

Associated symptoms include discharge, sneezing, itching, postnasal drip, reduced smell and snoring. Persistent one-sided obstruction with bleeding or unusual discharge requires assessment rather than an automatic allergy label.

Causes include allergic and nonallergic rhinitis, smoke or irritants, polyps, a deviated septum and some medicines. Overusing decongestant sprays can cause rebound congestion that prolongs symptoms.

Risk depends on the cause and includes allergy, irritant exposure, nasal structure, hormonal changes and medicines. A family history of allergy does not prove that the present blockage is allergic.

Assessment covers duration, seasonal variation and medicines, followed by nasal examination. Endoscopy, targeted allergy tests or imaging may be appropriate for suspected sinus or structural disease, not every blocked nose.

Saline, anti-inflammatory nasal sprays or allergy treatment may help depending on the cause. Use distilled, sterile or boiled-and-cooled water for rinsing. Limit decongestant sprays to their stated duration; surgery is considered only after appropriate assessment.

Possible effects include poor sleep, impaired smell, dry mouth and reduced quality of life. Misused decongestants perpetuate symptoms, and some sinus disorders need follow-up to prevent deterioration.

Reduce smoke and confirmed triggers and clean rinse equipment. Learn the prescribed spray technique and avoid sharing bottles. Ask before using decongestants during pregnancy or with heart disease or hypertension.