Blocked Nose
A blocked or congested nose is one of the commonest symptoms I see in my adult ENT practice. I see many patients with these symptoms and have treated large numbers both medically and surgically, often with very good outcomes. Some patients describe constant stuffiness. Others notice one side is worse than the other, or that the symptoms fluctuate through the day and night. For some, the main problem is difficulty breathing through the nose. For others, it is poor sleep, mouth breathing, post-nasal drip, reduced smell, facial pressure, or a sense that the nose never feels clear. Nasal conditions can also affect the throat, leading to cough, throat clearing, or a persistent feeling of mucus. Nasal blockage can have a significant impact on quality of life, and it is often caused by more than one factor at the same time.
What do patients usually mean by nasal blockage?
Patients often describe:
a blocked or stuffy nose
difficulty breathing through the nose, especially at night
alternating blockage from side to side
mouth breathing
reduced or altered sense of smell
post-nasal drip or mucus in the throat
facial pressure
snoring or poor sleep
a feeling that one side of the nose never clears
throat clearing or cough related to nasal symptoms
The pattern matters. Alternating nasal obstruction is an important symptom and often suggests that the turbinates, which are normal structures inside the nose that swell and shrink as part of the normal nasal cycle, are playing a significant part. Symptoms that are constant, strongly one-sided, or related to a past injury may suggest a structural problem. Many patients, though, have a mixture of both.
What can cause a blocked nose?
There is no single cause. Common possibilities include:
Structural problems
Sometimes the main issue is the shape of the inside of the nose.
The septum is the partition in the middle of the nose that separates the two nasal passages. If it is bent or deviated, it can narrow one side and make airflow worse.
The turbinates are normal structures on the side wall of the nose. They help warm, humidify, and filter the air you breathe. If they become enlarged, they can take up too much space and contribute to blockage.
The nasal valve is the narrowest part of the nasal airway, near the entrance to the nose. If this area is weak or narrow, airflow can feel restricted. In some patients, the soft outer wall of the nostril falls inwards on deep breathing. This is called alar collapse and it can make nasal breathing feel much worse. Where that is the issue, external nasal splints or nasal dilator strips can sometimes help by supporting the side wall. One example is these nasal dilators. Not all patients find them helpful. They are usually most useful in patients with significant alar collapse on deep inspiration and are often used when sleeping.
Rhinitis
Rhinitis means inflammation and swelling of the lining of the nose. It may be allergic, non-allergic, or mixed. Patients often notice blockage together with sneezing, itching, runny nose, catarrh, or fluctuating symptoms.
Chronic rhinosinusitis and nasal polyps
Inflammation in the nose and sinuses can lead to ongoing blockage, mucus, facial pressure, reduced smell, post-nasal drip, and sometimes cough or throat clearing. In some patients, polyps develop and further narrow the nasal airway.
Asthma
Asthma is often an important part of the picture. The nose, sinuses, and lungs are closely linked, and patients with asthma are more likely to have rhinitis or chronic sinus inflammation as well. When asthma and nasal inflammation coexist, both often need to be considered.
Decongestant spray overuse
Some patients develop worsening blockage because they have had to rely on decongestant nasal sprays for too long. These sprays can help in the short term, but overuse can lead to rebound congestion, where the nose becomes more blocked when the spray wears off.
Wider medical or systemic causes
Most blocked noses are not caused by a serious wider illness, but occasionally nasal symptoms are part of a broader inflammatory, autoimmune, or immune problem. This is one reason the history matters so much. In selected patients, persistent crusting, bleeding, recurrent sinus problems, or other symptoms elsewhere in the body may point towards something more than simple rhinitis or a deviated septum.
Why can a blocked nose affect the ears?
The back of the nose connects to the middle ear through the Eustachian tube. If the lining of the nose and the area around the back of the nose is swollen, that tube may not work properly. Patients can then notice blocked ears, popping, crackling, pressure, or muffled hearing. That is why a thorough review of nasal symptoms sometimes needs to include the ears as well.
When might it be something more serious?
Most adult nasal blockage is caused by structural change, rhinitis, or sinus inflammation rather than cancer. The concern becomes greater when symptoms are persistent, mainly on one side, or associated with blood-stained discharge, bleeding, pain, swelling, or eye symptoms.
What are the red flags?
Red flags include:
persistent blockage mainly on one side
blood-stained discharge
repeated unexplained nosebleeds, especially on one side
facial pain, swelling, or numbness
swelling around the eye, double vision, or reduced vision
a visible lump in the nose, mouth, face, or neck
severe crusting or bleeding that is not settling
symptoms that are steadily worsening rather than fluctuating
These symptoms do not automatically mean cancer, but they do mean proper ENT assessment is important.
How is it investigated?
The first step is a careful history. I want to know how long the symptoms have been present, whether one side is worse, whether there is allergy, sinus trouble, poor smell, previous injury, snoring, asthma, throat symptoms, or overuse of nasal sprays. I also want to know whether there are ear symptoms, because these can be part of the same problem.
I then examine the nose, throat, and ears, and in most cases I perform a nasal endoscopy in clinic. This is a thin camera used to look properly inside the nose and at the back of the nose. It allows me to assess the septum, turbinates, signs of rhinitis, polyps, sinus drainage areas, and anything more unusual that needs a closer look.
Not everyone needs further tests. Depending on the history and examination, additional investigations may include:
allergy testing
CT scanning of the nose and sinuses
blood tests
hearing tests or tympanometry if ear symptoms are prominent
biopsy or MRI in selected cases
The right investigation depends on the likely cause. A blocked nose is a symptom, not a diagnosis in itself.
What treatments help?
Treatment depends on the cause and on which factors are contributing most.
Medical treatment
Many patients improve with the right medical treatment. This may include saline rinses, steroid nasal sprays or drops, antihistamines, and treatment directed at rhinitis or sinus inflammation. Nasal steroid treatment often needs to be used properly and consistently for a period of time before the full benefit is seen.
Avoiding the wrong treatment
Decongestant sprays can be useful for a few days, but they are not a long-term solution. Using them for too long can actually make the blockage worse.
Surgery
For some patients, surgery is an important part of treatment. There are many possible surgical options depending on the problem, and in some cases more than one procedure may need to be carried out at the same time to address multiple areas contributing to the blockage.
This is why a thorough examination is so important. The aim is to work out exactly what is causing the blockage and then build the right treatment plan, rather than assuming every blocked nose needs the same operation.
Depending on the condition, I can offer different surgical options including septoplasty, whether open or closed where appropriate, turbinoplasty, and sinus surgery.
It is also important to understand that surgery is not always the whole answer. Some patients still need ongoing medical treatment afterwards, particularly where the underlying cause includes allergy, asthma, or chronic inflammation, as these cannot always be cured even if the nasal airway is improved. In these patients, one of the aims of surgery is to improve access so that medication can reach the areas it needs to reach and work more effectively.
How I approach this in clinic
When I assess a patient with nasal blockage, my aim is not just to confirm that the nose feels blocked. The real job is to work out why.
For some patients the main issue is a deviated septum. For others it is rhinitis, sinus inflammation, polyps, turbinate enlargement, nasal valve narrowing, spray overuse, or a combination of factors. Asthma can also be an important part of the picture, and some patients have ear symptoms because swelling around the back of the nose is affecting Eustachian tube function. In a smaller number of patients, the nasal symptoms are a clue to a wider medical problem.
Because I see so many patients with these symptoms, the focus is not simply on naming a diagnosis, but on identifying which factors matter most in that individual patient and building the right treatment plan. In some patients that means medical treatment alone. In others, surgery is an important part of improving the nasal airway and helping treatment work properly.
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Disclaimer
This page is intended as general information only. It does not replace a consultation, examination, or individual medical advice.
I have no financial interest in the products mentioned on this page.