Nasal Congestian

We have selected the following expert medical opinion based on its clarity, reliability and accuracy. Credits: Sourced from the website Patient UK, authored by Dr Laurence Knott, reviewed by Dr Helen Huins (see below). Please refer to your own medical practitioner for a final perspective, assessment or evaluation.

Overview

Nasal congestion is a blocked or stuffy feeling in your nose. It is caused by many different conditions. Some of these conditions settle on their own; others may need treatment.

There are several self-help strategies which work well to relieve nasal congestion. There are also sprays, tablets and medicines available over the counter or on prescription, which may make you more comfortable.

What is nasal congestion?

Nasal congestion is a blocked, stuffy or bunged-up feeling in your nose. Depending on the cause, it can last a short while (a few days) or can be persistent. In adults and children it is usually an annoying symptom rather than a serious one. In babies, however, a blocked-up nose may make it difficult to breathe or feed.

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

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 your throat when you lie down. Studies have shown that your immune system is more active at night.To make matters worse, you have no distractions, so your mind tends to focus on the sensations of your body. Try to sleep with your head propped up, if necessary using an extra pillow. Steam inhalations just before you go to bed may be beneficial. Keep the bedroom cool. Some people find they are affected by dry air; using a humidifier in the bedroom may help.

Causes

What causes nasal congestion?

The most common causes 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 your nose may be clear, yellow or green. It may be very watery, or may be thick and sticky. You may feel unwell or tired and develop a headache or a temperature (fever). You may have a cough.

Symptoms usually clear up after a few days. It may be helpful to take some medication to make you feel better while you wait for your immune system to fight off the germs. Over-the-counter medicines such as paracetamol or ibuprofen may be helpful. You may wish to use a decongestant medicine for the blocked nose.

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. 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.

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 1-4 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. 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 a blocked or stuffy nose. If you have hay fever, you usually also have itchy, watery eyes and sneeze a lot. Depending on which pollen you are allergic to, you will have symptoms 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.

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 you are allergic to (the allergen). The treatment is to avoid the allergen if possible. If this is not possible, treatment is similar to that for hay fever.

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.

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. If they shrink naturally, often nothing needs to be done. However, if they are causing problems they can be removed (often with the tonsils) by an operation.

If the dividing tissue between your 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 your nose has grown since you were born.

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.

Diagnosis

What tests are needed for nasal congestion?

If you have nasal congestion, often you won't need any tests. Your doctor can often determine the cause by asking questions about your symptoms and by examining you.

Sometimes, a referral to an ENT specialist is necessary. You may then have skin prick tests for allergy, or blood tests. The ENT specialist may also look further into the back of your 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?

In many cases of nasal congestion, there is no need to see a doctor. For example, if you have a common cold with no complications, or hay fever, you can often manage this yourself. A pharmacist may be able to help advise if you need some over-the-counter medication to help with the symptoms.

You should consider seeing a doctor if:

• Your nasal congestion is not getting better after a week or two despite trying the remedies suggested in this leaflet or the leaflet specific to the condition causing it.
• You are not sure what the cause is for your nasal congestion.
• You have any blood in the discharge coming from your nose.
• Only one side of your nose is blocked.
• You or your child are unwell with a high temperature (fever) as well as having nasal congestion.
• A baby has nasal congestion and is having difficulties feeding or breathing.
• You feel very unwell.

Treatment

What is the treatment for nasal congestion?

Where possible, the cause of the nasal congestion will be treated. However, the most common causes get better on their own. Either way, there are a number of treatments which improve a blocked or stuffy or runny nose, and make you feel better. These all tend to work for a short period of time and need repeating until the cause has gone away.

Steam inhalation

Always be very careful not to burn yourself with boiling water. Put boiling water from a kettle in a large bowl or basin, and set it on a table. Sit on a chair at the table and put your face over the bowl. Breathe normally for 5 or 10 minutes. Alternatively, you can buy a steam cup from a chemist. This is a plastic cup with a lid and mask. You put boiling water in the cup, fit the lid and mask and then breathe the steam through the mask. For small children, the safest method of steam inhalation is in the bathroom. Shut the door, and then turn on the hot shower and/or hot taps. Sit with your child (outside the shower as you want the water very hot) and look at a book or play with a toy for 5 to 10 minutes.

A steam cup

Salt water (saline solutions)

Salt water (saline) may be helpful to clear a blocked nose for a short time. You can buy saline drops from a chemist or get them on prescription. 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 you can buy 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 you rub on your chest so you breathe in the vapour, and oils which you add 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 the nose. 

Decongestant drops and sprays for the nose

Decongestant drops and sprays are very effective for a blocked nose and they will help to unblock your nose quickly. However they should only be used for a maximum of 5-7 days. If used for longer, you may have a rebound congestion when you stop them. 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 have been helpful.

The most commonly used decongestant drops or sprays are:

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

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

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 and on prescription. Always check with your doctor or pharmacist before taking them, as they are not suitable for everyone and may interact with other medication.

Steroid preparations for the nose

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 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 you will need a prescription. Always check with your doctor or pharmacist before using a steroid spray for nasal congestion.

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

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 your throat when you lie down. Studies have shown that your immune system is more active at night.To make matters worse, you have no distractions, so your mind tends to focus on the sensations of your body. Try to sleep with your head propped up, if necessary using an extra pillow. Steam inhalations just before you go to bed may be beneficial. Keep the bedroom cool. Some people find they are affected by dry air; using a humidifier in the bedroom may help.

About the author

Dr Laurence Knott

BSc (Hons) (Biochemistry), MB BS

Qualified 1973. 37 years experience in general practice. Medical author who has contributed to many lay and professional publications. Particularly interested in converting medical terminology into information comprehensive to non-medical readers. Clinical complaints adviser to the Medical Defence Union. External professional adviser to the Health Service Ombudsman. Extensive medicolegal practice specialising in clinical negligence. Listed on the National Crime Database, advising police forces and the Crown Prosecution Service on medicolegal aspects of criminal cases. Erstwhile GP medical adviser to the Guillain-Barré & Associated Inflammatory Neuropathies charity, now member and ex-patient.

Dr Helen Huins

MB BS Lond, DCH, DRCOG, MRCGP, JCPTGP, DFFP

Helen qualified at Guy’s Hospital in 1989 and left London in 1990 to settle in the countryside. She works as a GP partner in a rural dispensing practice and is passionate about family medicine and continuity of care with interests in sport and nutrition. Helen has been a member of the EMIS authoring team since 1995.

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