Nasal Congestion

Reviewed by Professor Paul Chatrath, Consultant ENT Surgeon

What are the symptoms of nasal congestion?

If you suffer from nasal congestion, you have a feeling of reduced airflow through one or both nostrils. When the inside of your nose becomes inflamed and swollen, the nasal passages get narrower. This restricts airflow and makes it harder to breathe through your nose.

You also produce more mucus (a thick, wet liquid) to help flush out whatever is causing the irritation. The build-up of mucus may cause a runny nose. If the extra mucus runs down the back of your nose to your throat, you may get a cough or sore throat.

Other possible symptoms may include:

• sneezing (this is usually more severe if the nasal congestion is caused by an allergy)
• a headache
• an itchy or irritated nose
• a reduced sense of smell
• a crust inside the nose (this is not common)

Nasal congestion often settles quickly, but sometimes the problem continues. The uncomfortable blocked feeling in your nose may disrupt your daily activities. You may feel tired and find it difficult to concentrate, especially if the symptoms affect your sleep. It is then important to see a doctor and get treatment to improve your quality of life.

What causes nasal congestion?

There are various reasons why the thin, moist lining inside your nose can become swollen. The main causes of nasal congestion are:

• Infection: The viruses that cause a cold or the flu often enter your body directly through the nose. They attack the lining of your nose and throat. This causes inflammation and a blocked or runny nose. The nasal congestion usually starts to improve within a week. Occasionally, bacterial or fungal infections can cause nasal congestion.
• Allergies: About one in five people in the UK have a condition called allergic rhinitis. Certain triggers, such as pollen, dust or flakes of skin from cats or dogs, can create an allergic response. This makes the nose lining swell up and produces cold-like symptoms, such as a blocked or runny nose, itching and sneezing.
• Medicines and drugs: Taking certain medicines can sometimes lead to nasal congestion. For example, if you have a cold, you can buy decongestant nasal sprays from the chemist to unblock your nose. It is safe to use these sprays for up to seven days at a time. If you use the sprays for a longer period, your nose lining can swell up again. This is likely to make the original problem worse. The misuse of recreational drugs, such as cocaine, can also cause nasal congestion.
• A condition called turbinate hypertrophy: The turbinates are small structures inside your nose, which help to warm and moisten air that flows through the nostrils. If you have a condition called turbinate hypertrophy, the turbinates become large and inflamed. This can block airflow and result in nasal congestion.
• A problem with the structure of the nose: Nasal congestion can be caused by a problem with the structure of your nose, such as a deviated septum. The septum is a thin piece of bone and cartilage (tissue) between the right and left sides of your nose. You may be born with a septum that is bent (deviated) to one side or an injury may move it out of position. A deviated septum does not always cause problems. However, if the septum is severely bent, this can block one side of the nose and reduce airflow. You may find it harder to breathe through one nostril.
• A collapsed nostril:  When you breathe in through the nose, it is normal for the sidewalls of the nostrils (the nasal valves) to collapse inwards slightly. Sometimes, these sidewalls of the nose become weaker than normal. This may happen as a result of the normal ageing process, an injury or previous nose surgery. If you have a weak sidewall in the nostril, it is harder to withstand the normal way that your nose collapses inwards. You may find it difficult to breathe through the nose, especially when you lie down or exercise, and have a blocked feeling. Your nose may also bleed and become crusty around the nostrils.
• Sinusitis (sinus infection): The sinuses are the air pockets around your nose. They make thin mucus that drains out of the nose and keeps it clean and free from bacteria. An infection of the sinuses is called sinusitis. The sinuses become swollen and filled with fluid because the mucus cannot drain away. This can cause a high temperature, yellow or green mucus, facial pain, a headache, a reduced sense of smell and a blocked nose.
• Nasal polyps: Nasal polyps are soft, non-cancerous growths inside your nose. They can be linked to an allergy or infection, but the exact cause of them is unknown. Polyps are usually harmless swellings, but can block your nose if not treated. Although each individual polyp is small, larger growths or groups of polyps can fill up the inside of your nose. This can cause a blocked or runny nose, loss of smell, sneezing and a constant need to swallow (called post-nasal drip).

What tests do I need to diagnose the cause of nasal congestion?

If nasal congestion affects your everyday life, it is a good idea to make an appointment with your GP. They will ask you about your symptoms, medical history and any medicines that you take. You may also have a blood test.

Your GP may refer you to a specialist Ear, Nose and Throat (ENT) Department. We examine you and may carry out various tests to find out what is causing your blocked nose:

• Allergy tests: You may have a skin prick test to check whether you have an allergy. If we suspect that you may be allergic to something, we gently prick your skin with a tiny amount of this substance. We then watch how your skin reacts.
• Nasal endoscopy: We may look inside your nose with a thin, flexible tube called an endoscope. This tube has a light and a small camera at the end. We can see whether you have an infection in your nose or sinuses and any blockage, such as nasal polyps.
• Scans: Occasionally, you may need to have a CT or MRI scan. This gives us detailed pictures of the inside of your nose and sinuses if we suspect that there is an obstruction.

How can nasal congestion be treated or managed?

The treatment that you need for nasal congestion depends on what is causing your symptoms. In some cases, you may not need specific treatment. If you have a viral infection like a cold, your symptoms should get better on their own in one or two weeks. In other cases, you may need simple or more complex treatments to improve a blocked nose.

Non-surgical treatments

You can try home remedies and non-surgical treatments to relieve your symptoms:

• Steam inhalation: This is when you breathe in steam from heated water to clear your nose and sinuses. You put a towel over your head and inhale the steam from a bowl of boiled water for 10 to 15 minutes. Be careful not to burn yourself with hot water. You can repeat this process two or three times a day. The warm, moist air helps to loosen mucus and reduce the blocked feeling in your nose.
• Drinking lots of fluids: If you drink plenty of fluids every day, this helps to keep the mucus that you produce thin and to drain more quickly.
• Nasal strips: You can buy a packet of nasal strips from the chemist. They are sticky strips made of spring-like bands, which lift the sides of your nose and open the nasal passages. You may then find it easier to breathe at night if you have a cold, allergy or deviated septum. The strips can also prevent weak sidewalls of the nostrils from collapsing inwards.

Treatments for allergic rhinitis
If your nasal congestion is caused by an allergy, try to avoid coming into contact with whatever triggers your symptoms. These treatments may also help:

• Antihistamines: Antihistamine tablets and nasal sprays treat allergy symptoms, including nasal congestion. They work by blocking the effects of a chemical called histamine, which your body releases during an allergic reaction. It is important to use antihistamines with care because some medicines can make you drowsy (sleepy).
• Steroid nasal sprays: Your doctor may recommend that you use a steroid nasal spray. This reduces swelling and inflammation inside your nose. It takes longer to work than an antihistamine spray, but lasts longer. Adults can safely use a steroid nasal spray as a long-term treatment if needed. Steroid nasal sprays can also treat small nasal polyps.
• Saltwater rinses: If you regularly rinse your nose with a saltwater solution, it helps to clear any excess mucus or irritants. This treatment is called nasal douching (showering) and reduces inflammation. You can use a homemade saltwater solution or buy sachets from the chemist. Small syringes or pots are also available to flush the solution around your nose. Saltwater rinses are helpful on their own or together with steroid sprays.

Surgery

If home remedies and non-surgical treatments do not relieve your symptoms, you may need surgery.

We carry out various procedures to treat nasal congestion, including:

• Turbinate reduction (Turbinectomy): If the bony structures called turbinates in your nose are big and swollen, we can reduce their size in different ways. We can shrink the lining of the turbinates by heating it with a needle-like instrument that gives out energy waves. In other cases, we may partially remove or reposition the turbinates. These are all routine procedures to improve the airflow in your nose and make it easier to breathe.
• Septoplasty: A septoplasty is a surgical procedure to correct a deviated septum, where the thin wall between your nostrils is bent to one side. We straighten the bent wall made of cartilage and bone and reposition it in the centre of your nose. After the procedure, there should be better airflow through your nose and the blocked feeling should improve.
• Nasal valve surgery: If you have a collapsing nostril caused by a weak sidewall (nasal valve), we can strengthen it in different ways. For example, we can add extra cartilage to give your nose more structural support. We can put an implant made of a metal called titanium under the skin of your nose. This prevents the sidewall from collapsing inwards when you breathe in air. Another option involves creating skin flaps inside the nose to widen and strengthen the nasal valve.
• Sinus surgery: If you have chronic sinusitis (long-term problems with sinus infections), you may need surgery to improve the drainage of your sinuses. We perform minimally invasive keyhole surgery through the nostrils, with no cuts or stitches on your face. The surgeon widens the entrance to your sinuses and relieves the build-up of pressure. They can do this by removing blocked tissue or inflating a tiny balloon to open the sinuses.
• Nasal polypectomy: If you have nasal polyps and a steroid spray does not help, you may need surgery to remove these swellings. We usually insert an endoscope with a light and small camera into your nose. Using tiny instruments, we can then remove the nasal polyps and correct any problems with your sinuses. Most people’s symptoms improve when the polyps are removed, but they may grow back within a few years.