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What is blocked nose?

Causes for obstruction in the nose may include a tumour or polyp, or a structural blockage, such as a deviated septum 1. When there is inflammation with swelling, it becomes difficult for mucous to drain2. Nasal congestion is often caused by1:

  • The common cold
  • Flu
  • Hay fever / allergic rhinitis
  • Acute sinusitis.

Nasal congestion plays a protective role, defending the body against infection by increasing the temperature of the nasal lining towards 37 °C.

This interferes with a virus’s ability to multiply (or replicate)3. However, chronic nasal congestion can impact daily life in various ways by giving rise to:

  • Fatigue
  • Disrupted sleep
  • Trouble concentrating
  • Poor memory
  • Low productivity.

Types

Nasal congestion can be acute or chronic2. Acute nasal congestion is mostly caused by1:

  • Common colds
  • Flu
  • Intermittent allergic rhinitis
  • Acute rhinosinusitis (where both the nose and sinusitis are inflamed).

Chronic nasal congestion is an inflammatory disease and typically goes with other inflammatory diseases, such as hay fever and asthma5. Other possible causes of a chronic blocked nose include polyps, a deviated septum, enlarged adenoids, tumours, overuse of nasal decongestants, or enlargement of the bony structures located inside the nose.1,6.

Clinical presentation

With acute rhinosinusitis where there is inflammation of the nasal passages and sinuses, two or more of these symptoms come on suddenly2:

  • Sneezing
  • Post-nasal drip
  • Facial pain or pressure
  • Impaired or loss of smell
  • Discoloured mucous
  • Cough.

If the acute infection is bacterial, at least three of the following signs and symptoms will be present7:

  • Discoloured mucous which is worse on one side
  • Severe pain over a specific area mostly on one side
  • Fever higher than 38 °C
  • Elevated inflammatory markers
  • Double sickening – where your condition gets worse.

The condition is considered chronic when symptoms last for 12 weeks or more2. There may or may not be polyps in the nose2.

Risk factors

In most cases, nasal congestion is caused by a viral infection7. When it’s bacterial, this is usually a secondary infection following an initial viral infection7. Other risk factors for nasal congestion include:

  • Allergies: An allergic reaction can lead to nasal congestion as a result of inflammation1. Allergic rhinitis is also commonly associated with nasal congestion1.
  • Smoking: Can damage the cilia in the nose, interfering with mucous clearance and increasing the risk of infection7.

Diagnosis

An examination by a healthcare professional is usually enough for a diagnosis1. In the case of chronic symptoms, the healthcare professional may use a scope to check for polyps1. He/she will also take a detailed history of allergy symptoms and may refer you for an allergy test, if necessary1.

If the healthcare provider suspects complications, he/she may refer you for additional tests, such as a CT scan1.

Treatment

Treatment principles

Treatment aims to relieve symptoms and improve quality of life5. This is achieved by:

  • Enhancing the body’s natural mucous-clearing system by addressing inflammation and physiological changes in the sinus passages2,5
  • Improving sinus drainage5
  • Eradicating infection5
  • Reducing inflammation5
  • Making way for topical medication5.

Treatment options

  • Nasal saline rinse, administered as a spray, nasal shower, irrigation, insufflation, fumigation or aerosol2,8
  • Nasal decongestants2
  • Intranasal steroids only if symptoms don’t go away2
  • Antibiotics for bacterial infections only2
  • Painkillers2.

Prevention

To avoid nasal congestion from progressing to sinusitis, it may help to:

  • Avoid triggers, such as allergens and irritants that trigger nasal allergies
  • Keep the nasal passages clear, especially if you have allergies
  • Wash your hands often, especially during the common cold season
  • Avoid touching your face.9

Helpful tools

Saline nasal solutions are available over the counter and can be used on their own or in conjunction with other treatments, such as steroid nasal sprays and oral antihistamines10. Saline can be administered in various ways, but saline nasal sprays are the most convenient and easiest to use – except in the case of young children, where saline nasal drops are often preferred10.

Tips for using a nasal saline spray10:

  • Use a sterile saline nasal spray
  • A slightly hypertonic solution may give better results
  • Spray one or two puffs into each nostril
  • Aim for the inside of the lateral nasal wall (the outer side of the nostril, as opposed to the septum)
  • If you have been diagnosed with hypertension, consult with your healthcare provider before using a saline nasal spray.