It’s more than a sniffle. Your nose gets clogged, stays clogged, and then whistles or hisses when you breathe. Your face aches. You blow through box after box of tissues. It just won’t go away.
Chronic congestion is common, says Dr Mark Dykewicz, an allergist and immunologist at Saint Louis University School of Medicine, but treating it can get complicated — in part because there are so many potential causes. Here’s what to know.
Nasal congestion is very common, even when you don’t seem to be sick.Credit:iStock
Why am I so stuffed up?
There are many potential triggers for nasal congestion, including household and workplace irritants, allergies and upper respiratory infections.
The anatomy of your nose could also be a culprit, Dykewicz says. Some people are born with or develop a deviated septum, in which the thin wall of cartilage and bone that separates the right and left nasal passage is off-centre. That makes one nasal passage larger than the other, Dykewicz says, and the smaller side can get stuffed up easily. Some people also become congested when the septum and nearby structures weaken and start to cave in over time, or when the turbinates — small, bony plates inside the nose that cleanse, heat and humidify the air you breathe in — become enlarged.
Seasonal allergies are one obvious source of congestion — especially if you have watery, itchy eyes in addition to a runny nose, and you’re also sneezing. But other kinds of environmental allergies can gunk up your nose year-round, says Dr Sarah Hochman, an assistant professor of medicine at NYU Grossman School of Medicine. Pet hair, dander, saliva and urine can enlarge and inflame the soft tissues in your nose, causing congestion, as can dust mites. And everyday irritants such as perfumes, car exhaust and cigarette smoke can cause our noses to react, Dykewicz adds.
Viral infections such as the common cold, flu and COVID-19 can also lead to congestion, as can viral pneumonia. Other factors include temperature and humidity changes, Dykewicz says, although some people have chronic inflammation with no known cause.
If your nose is persistently blocked for longer than two weeks, and especially after you have had a cold, you may have a sinus infection, Hochman says, which is an inflammation of the sinus tissue. Other telltale signs of a sinus infection include earaches, fever and pain when you touch your cheeks. If you have sinus congestion and your face or forehead also hurts when you lean over (to tie your shoes, for example), Hochman says, that could be another sign of a sinus infection and you should seek medical care.
Congestion can also be a surprising byproduct of some medications, including Viagra and some blood pressure-lowering ACE inhibitor drugs, Dykewicz says. So if you’re grappling with chronic congestion, it’s important to look up the potential side effects of any medications or supplements you may be taking and consult with your prescribing doctor.
How to clear up congestion
It may sound simple, but first try clearing out your nose as much as possible by gently blowing into a tissue, says Dr Raj Sindwani, an otolaryngologist at the Cleveland Clinic. You can use an over-the-counter saline nasal spray to help irrigate your nasal passages two or three times a day, Dykewicz says. It’s also important to stay hydrated, as fluids can help thin the mucus in your nose, allowing it to drain more easily. A steamy shower can help open up your nasal passages, too, Hochman says.
Certain over-the-counter medications may help combat congestion, although many come with caveats, Dykewicz says.
If allergies are the root cause of your congestion, your doctor may recommend an oral antihistamine such as cetirizine (Zyrtec) or fexofenadine (Allegra) for mild symptoms. Most antihistamines are safe to take in the long term, Hochman says, but if you’re going to use them for more than a week or two, you should consult a doctor.
For more severe symptoms, medicated nasal sprays may help, but some are safer for long-term use than others, Dykewicz says. Steroid nasal sprays that contain active ingredients such as fluticasone, triamcinolone or budesonide are safe to use for as long as you need them, Sindwani says. “No problem, you can use those ad infinitum,” he says.
But nasal sprays that contain decongestants such as oxymetazoline or phenylephrine should be used for no longer than three to five days, or you risk what doctors call “rebound congestion,” Dykewicz says. These medications cause your blood vessels to constrict, opening up your nose for a brief period of relief — but then, if used repeatedly, the mucosal surfaces in your nose could swell, Hochman says, and some people end up feeling worse than before. There is some risk that, after long-term use of these nasal sprays, swelling could become persistent and require additional treatment such as with steroids, Dykewicz says.
“The nose gets stuffier and stuffier,” Dykewicz says. “People become de facto addicted to it.”
If chronic congestion is interfering with your daily life, Hochman says, you should seek care from an ear, nose and throat doctor who can investigate whether your nose has a structural issue or whether you have something like a chronic sinus infection.
“Everyone has a different threshold above which they can’t take it anymore,” she says.
This article originally appeared in The New York Times.
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