The How's and Why's of Nasal Congestion

congestions02.pngNow that the holidays have come and gone and life starts to drift back to normal, many of us start to wonder the same thing - "where did this nasal congestion come from?" This kind of congestion in incredibly common this time of year, and it can be an annoying and disruptive hinderance in our lives. Most of the time it is the world around us (allergies, fumes, dust, etc.) that causes the obstruction. Sometimes the nose itself is the problem. Either way, nasal congestion is a significant nuisance. And occasionally it is more than just bothersome, indicating a more concerning problem like an infection.

Regardless of cause, nasal stuffiness is not fun. And, most people are not at their best when they can’t breathe comfortably through their nose.

The four main conditions (and their treatments) that cause nasal congestion are listed below:


Rhinitis (or nasal inflammation in regular English) has several common causes, the most frequent being allergies. Allergens (or things that float in the air just to irritate you) are a plant pollens or other very tiny bit of animals, insects, or molds that incite a riot when they hit the inside of your nose.

Histamine is one of many chemicals your body releases when exposed to an allergen. The result is a mess! Nasal linings swell, a huge amount of nasal mucous pours out of the nose, and you might sneeze like crazy. This is why there is a big market for ANTI-histamines. Brand name meds (Allegra, Alavert, Benadryl, Chlortrimeton, Claritin, Tavist, and Zyrtec to name a few) and their corresponding generics are easy to get over the counter. They work quickly and effectively to block histamine and its effects. They can cause sedation so keep that in mind when you take them.

Oral decongestants (for instance Sudafed among others) are helpful for symptom relief as well. People with high blood pressure, glaucoma, and prostate enlargement need to be very careful with this sort of medication, though. And because they are sometimes combined with the antihistamines above, be sure to check the label to make sure you are not giving yourself a bigger problem.

Non-prescription nasal anti-inflammatory steroid sprays (Nasacort, Rhinocort, and Flonase and their generics) are also available. These safe, topical medicines target a wider variety of inflammatory chemicals and can make a big difference for prolonged allergic irritation. They don’t work quickly, like antihistamines, and must be applied consistently for effect.

At Ashford Clinic, we treat allergies with effective and convenient Allergy Drops, make an appointment to get allergy tested to learn more.

Non-Allergic Rhinitis

Sometimes the nasal inflammation is caused by things that just irritate you. Your nose responds to these less acutely than what you experience with a typical allergy. Chronic congestion and post nasal drainage are the more common symptoms.

Triggers for non-allergic rhinitis include fumes, smoke, dust, chemicals, perfumes, and smog. Pregnancy also commonly blocks up the nose – just another gift from your firstborn.

Treatment is just as non-specific as the cause. Nasal anti-inflammatory steroid sprays are the best and most effective approach to controlling the irritation. Antihistamines are usually not very helpful.

As an aside, the chronic use of OTC nasal decongestant sprays (Afrin and Neosynephrine are the two most common villains) leads to persistent engorgement of the nasal lining. The only way to get relief is continued use of the spray which shrinks the swelling, which leads to more swelling, which leads to needing more spray. The cycle is common. The best approach is to stay away from these sprays in the first place. But if you are stuck, use nasal steroids consistently until they can control the irritation and get you off the decongestant spray.

Viral and Bacterial Infections

According to the American Academy of Otolaryngology – Head and Neck Surgery, the average adult contracts the common cold two or three times a year. Kids may get even more, up to 9 per year, until they build up defenses against the common viruses that cause “colds.” The symptoms are obvious to anyone who has had one – raise your hand if you haven’t had a cold: nasal congestion, runny nose, headache, cough, fever, and “the blahs.” The average viral upper respiratory infection lasts 10-14 days and there is really nothing you can do about it. No antibiotics will help (no matter how much you beg your doctor). They body has to fight off the virus and heal at its own pace.

Occasionally, an allergy or viral cold can trigger a secondary bacterial infection in the nose and sinuses. Typically, 7-10 days into the cold the symptoms worsen again, this time with a vengeance. Congestion and drainage persist and are accompanied by thick and significantly discolored mucous. The headache becomes more localized around the eyes, in the forehead, and/or in the cheeks. The malaise continues and sometimes worsens. NOW you have a case to make with your doctor for antibiotics. Nasal salt water rinses are also very helpful.

When an acute sinus infection doesn’t go away (with or without medications that may include antibiotics and even oral steroids) it can become a chronic problem. After months of ongoing nasal congestion, drainage, and headache, a visit with an Ear, Nose, and Throat specialist is needed. Chronic sinusitis may need surgical intervention if medications are insufficient to provide relief.

Structural problems

The space inside your nose is a very complicated. The septum is the narrow wall of cartilage and bone that separates the two sides. It can be crooked (or deviated) and block airflow. The turbinates, which are structures on the side walls of the nose, can be large and obstructive. They may also cause congestion due to engorgement in reaction to chronic inflammation.

Fortunately for chronic obstruction there are very effective procedural interventions to straighten the septum and/or reduce the size of the turbinates. Some are even done right in the office under local anesthesia.

Give Ashford Clinic a call at 706-248-6860 for help with your Nasal Congestion and other ENT issues.