Nasal Congestion

What is nasal congestion?

Nasal congestion is a blocked, stuffy or bunged-up feeling in the nose. Depending on the cause, it can last a short while (a few days) or can be persistent. It is usually an annoying symptom rather than a serious one.

Some of the causes of nasal congestion are discussed below. There may be other symptoms along with the blocked nose.

What causes nasal congestion?

The most common causes of nasal congestion are:

• Infections: the common cold and other respiratory tract infections, including influenza (flu) and sinusitis.
• Allergies, including hay fever.
• Persistent rhinitis.
• Nasal polyps.

Other less common causes of nasal congestion include:

• Swollen adenoid glands.
• Injuries to the nose.
• Foreign bodies in the nose.
• Rebound congestion after stopping decongestant medication.
• Tumours of the sinuses or inside of the nose.
• Side-effects of some medication.

The common cold

Nasal congestion occurs with a common cold. The discharge from the nose may be clear, yellow or green. It may be very watery, or may be thick and sticky. A headache, tiredness, feeling of being generally unwell or a temperature (fever) may be associated with it. There may be a cough. The common cold is caused by a virus; antibiotics never help.

Nasal congestion symptoms usually clear up after a few days. It may be helpful to take some medication to reduce some of the symptoms whilst waiting for the immune system to fight off the germs. Over-the-counter medicines such as paracetamol or ibuprofen may be helpful for headaches or fever. A decongestant medicine may help the blocked nose. See the separate leaflet called Common Cold (Upper Respiratory Tract Infections) for more details.

Flu (influenza)

Flu is a viral infection that causes sneezing and nasal congestion. It tends to make people feel very much more unwell than a common cold, with high fevers, exhaustion, aches and pains. Treatment is usually similar to that for the common cold. Antibiotics also are not used.

However, some more vulnerable people may need an antiviral treatment, such as oseltamivir (trade name Tamiflu®) and zanamivir (trade name Relenza®). These are only used for people who are at risk of developing complications from flu. See the separate leaflet called Influenza and Flu-like Illness for more details.

Sinusitis

The sinuses are small, air-filled spaces inside the cheekbones and forehead which drain into the nose. Sinusitis means inflammation of a sinus. Most bouts of sinusitis are caused by an infection. Most cases of sinusitis are acute (lasting one to four weeks) but some may go on to a more persistent (chronic) sinusitis.

The symptoms of sinusitis are mainly nasal congestion, and pain in the area of the affected sinus. This is most commonly in the forehead or cheeks on one or both sides of the nose. The pain may be worse on bending down. Other symptoms which may occur are dizziness and fever.

Sinusitis is usually treated with painkillers and decongestants. Occasionally antibiotics are needed, if the symptoms have persisted for three weeks or more. See the separate leaflets called Acute Sinusitis and Chronic Sinusitis for more details.

Hay fever

Hay fever is caused by an allergy to pollen and is a common cause of nasal congestion or a stuffy nose. Hay fever usually also causes itchy, watery eyes and sneezing. Depending on which pollen is causing the allergy, symptoms of nasal congestion will usually occur for one particular part of each year. In the UK, this is typically late spring to early summer.

The usual treatment for hay fever is antihistamines (as tablets, medicines or sprays), steroid nasal sprays or steroid nasal drops. See the separate leaflet called Hay Fever and Seasonal Allergies for more details.

Allergic rhinitis

Rhinitis is swelling (inflammation) of the tissues lining the inside of the nose. It can be due to allergies (allergic rhinitis) or other causes (non-allergic rhinitis). In addition to pollen, other allergies can cause nasal congestion.

Symptoms are similar to those of hay fever. It may be possible to have tests, such as skin prick tests or blood tests, to see what is causing the allergy (the allergen). The treatment is to avoid the allergen if possible. If this is not possible, treatment is similar to that for hay fever.

See the separate leaflet called Persistent Rhinitis (Sneezing) for details of the causes and treatments of both allergic rhinitis and non-allergic rhinitis.

Nasal polyps

Nasal polyps are fleshy, non-cancerous (benign) swellings that grow inside the nose or sinuses. The most common symptom they cause is a stuffy, runny nose. Steroid nasal drops are commonly used to shrink the polyps.

An operation is sometimes needed. Nasal polyps often return after treatment, so steroid nasal sprays are sometimes used daily to prevent them from returning. See the separate leaflet called Nasal Polyps for more details.

Other causes of nasal congestion

Swollen adenoid glands may cause nasal congestion, particularly in children. Adenoid glands are fleshy bits of tissue which hang down from the back of the nose and are part of the immune system. Usually they do not cause long-term problems.

However, if they do cause problems they can be removed (often with the tonsils) by an operation. For more details, see the leaflet called What do tonsils do?

If the dividing tissue between the two nostrils (nasal septum) is not straight (deviated septum), this can cause nasal congestion. It can be the result of injury or just the shape into which the nose has grown since birth.

Children may get objects such as beads or peas stuck up their noses. Rarely, a tumour in the airways around the nose or sinuses may cause congestion.

What is the treatment for nasal congestion?

Where possible, the cause of the nasal congestion will be treated. However, the most common causes of nasal congestions get better on their own without specific treatment. There are a number of nasal congestion treatments which improve a blocked or runny or stuffy nose:

• Steam inhalation.
• Salt water (saline solutions).
• Menthol vapours, rubs and pastille.
• Decongestant drops and sprays for nasal congestion.
• Decongestant tablets and syrups.
• Steroid sprays.

These all tend to work for a short period of time and need repeating until the cause has gone away.

Steam inhalation

It is very important to be careful not to burn oneself with the boiling water.

Boiling water from a kettle can be placed in a large bowl or basin and set on a table. Whilst sitting at a chair at the table, the face is held over the bowl whilst breathing normally for five or ten minutes.

Alternatively, a steam cup can be bought from a chemist. This is a plastic cup with a lid and mask. Boiling water is put in the cup, the lid and mask is fitted on top and then the steam is breathed through the mask.

For small children, the safest method of steam inhalation is using the shower in the bathroom. The door should be shut and the hot shower or taps turned on using very hot water. The parent can then sit with the child in the bathroom (not in the bath or shower as the water needs to be very hot) whilst looking at a book or playing with a toy for five to ten minutes.

A steam cup example

By Dr Mary Harding - Patient.info©

Salt water (saline) solutions

Salt water (saline) may be helpful to clear a blocked nose for a short time. Saline drops can be bought from a chemist. They are sometimes used in babies who are congested so they are better able to feed.

There are also saline sprays and solutions which aim to wash out the passageways of the nose. These all make the gunk blocking the nose more liquid, so that it drains out more easily.

Menthol vapours, rubs and pastilles

There are many products which contain ingredients such as menthol or eucalyptus oil, which can be bought over the counter for nasal congestion. The most well-known of these are Vicks® and Olbas® but there are many others which work in the same way.

They are available as vapour rubs, which are rubbed on the chest so that the vapour can be breathed in and oils which are added to hot water for steam inhalations. There are also throat sweets to suck. These soothe a sore throat but also release a vapour to help clear nasal congestion.

Decongestant drops and sprays for nasal congestion

Decongestant drops and sprays are very effective for nasal congestion and they will help to unblock the nose quickly. However they should only be used for a maximum of five to seven days. If used for longer, there may be a rebound nasal congestion (which can be worse) when they are stopped. They cannot be used by children under the age of 6 years. Children aged 6 to 12 years may use them for up to five days if none of the options above has been helpful.

The most commonly used decongestant drops or nasal sprays are:

• Ephedrine.
• Xylometazoline.
• Oxymetazoline.
• Ipratropium (only from age 12 years).

They come in several different brand names and are available over the counter.

See the separate leaflet called Decongestants for more details on decongestant drops, and also about decongestant tablets and medicine (see below).

Decongestant tablets and syrups

Decongestants in the form of tablets or liquid medicines (syrups) are thought to be safer to take for a longer time if need be. The main ones used are pseudoephedrine and phenylephrine. They come in several brand names.

They are available over the counter but it is important to check with the pharmacist before taking them, as they are not suitable for everyone and may interact with other medication.

Steroid nose sprays

Steroid sprays are often used for nasal congestion, particularly when it is caused by allergies such as hay fever or by nasal polyps. Steroid sprays work by reducing the swelling of the inside of the nose. The nasal spray should be applied directly to the inside of the nose.

Steroid nasal sprays are safe for adults to use in the long term if needed. There are several types of steroid spray and they come in several brands. Some are available to buy from chemists or supermarkets; for others a prescription is needed.

. See the separate leaflet called Steroid Nasal Sprays for more details.

Steroid nasal drops are more readily absorbed than sprays and can cause similar side-effects to steroid tablets. They should therefore be used cautiously.

How should I sleep with nasal congestion?

Nasal congestion is often worse at night because the effect of gravity makes mucus pool at the back of the throat on lying down. Studies have shown that the immune system is also more active at night.

To make matters worse, there are fewer distractions so the mind tends to focus on the body's sensations. It can help to sleep with the head propped up, if necessary using extra pillows.

Steam inhalations just before going to bed may be beneficial for nasal congestion. Keeping the bedroom cool may also help. Some people find they are affected by dry air; using a humidifier in the bedroom may help.

What tests are needed for nasal congestion?

It is rare to need tests for nasal congestion. Normally a healthcare professional will be able to determine the cause by asking questions about symptoms and by examination. Sometimes blood tests can help determine an underlying allergy.

Sometimes, a referral to an ENT specialist is necessary. They may recommend skin prick tests for allergy or may look further into the back of the nose with a flexible telescope (nasoendoscopy). Very occasionally, a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan may be needed.

When should I see a doctor for nasal congestion?

In most cases of nasal congestion, there is no need to see a doctor. For example, a common cold with no complications, or hay fever, should be managed at home. A pharmacist may be able to advise about over-the-counter medication to help with the symptoms.

Medical advice should be considered if:

• The nasal congestion is not getting better after two weeks despite trying the remedies suggested in this leaflet or the leaflet specific to the condition causing it.
• There is no clear cause is for your nasal congestion.
• There is blood in the discharge coming from the nose.
• Only one side of the nose is blocked.
• A baby is having difficulties feeding or breathing due to the nasal congestion. Babies have very small noses so often sound congested and make a lot of snuffling noises; however, if they are breathing faster than usual, if their chest wall is moving in and out more than normal, if they are using their tummy muscles whilst breathing or if they are not drinking as much as usual, these are all reasons to consult with a doctor.
• Feeling very unwell.