Nasal Congestion: Main Causes and When It Is a Concern

A nose that cannot breathe is always inconvenient: you cannot fall asleep at night, your head feels heavy during the day, food has no taste. The picture is familiar, especially during the heating season. Let us look at what causes congestion, what happens inside, and when it is time to see a doctor.

What nasal congestion is and how it occurs

A stuffy nose is a condition caused by blockage of the nasal passages. The usual cause is swelling of the membranes lining the nasal cavity due to inflammation of the blood vessels: the tissues swell, the lumen narrows, and air passes with difficulty. A runny nose is often added.

What happens inside. If mucus runs down the back of the throat (postnasal drip), a cough or sore throat appears. With sinusitis, the lining of the sinuses swells — small empty spaces behind the cheekbones and forehead connected to the nasal cavity; swelling prevents mucus from draining, and a feeling of congestion appears.

Infectious causes: cold, rhinitis, sinusitis

Congestion can be caused by a cold, flu and sinusitis. With a cold, congestion usually resolves on its own within a week. Sinusitis is swelling of the sinuses, most often against a background of infection; it often begins after a cold or flu and in most cases resolves on its own within 4 weeks.

With sinusitis, the cheeks, the area around the eyes or the forehead hurt and are tender to the touch, the nose is stuffy or runny, the sense of smell is reduced, the mucus is green or yellow, and there may be a fever. Headache and toothache, bad breath, cough, pressure in the ears, snoring and a nasal voice are added. In young children — restlessness, difficulty feeding, mouth breathing. A runny nose together with a fever is a reason to see a doctor.

Allergic nasal congestion

Congestion is also caused by hay fever and other allergies. Pollinosis is an allergic reaction to plant pollen, most often to grass pollen.

Why the nose gets stuffy when lying down and without an obvious cause

Congestion often worsens when you lie down. Turning upside down can also cause inflammation of the vessels and a feeling of a blocked nose.

If the nose is stuffy without a cold or allergy, the causes may be non-obvious: nasal polyps (growths of inflamed tissue), deviated septum, hypertrophy of the nasal turbinates, vasomotor rhinitis, pregnancy due to increased blood flow, a reaction to certain medications. A separate story is medication-induced rhinitis: congestion as a reaction to prolonged use of decongestant drops; such remedies, when used for longer than 3 days, can worsen congestion.

Psychosomatics and other unusual causes

There is no convincing evidence that the nose gets stuffy "from nerves." But there are non-obvious physical causes: pregnancy, a reaction to medications, polyps, hypertrophy of the turbinates, empty nose syndrome. There are also theoretical suggestions of a link between chronic rhinosinusitis and gastroesophageal reflux.

When the nose does not breathe for a long time and you need to see a doctor

If symptoms last more than 3 weeks, it is time to see a doctor. If there is no improvement after 7 days of help at the pharmacy or from a doctor — likewise. Frequently recurring sinusitis and children aged 11 and younger are separate reasons for a visit.

You need to get help quickly if the person feels very unwell, painkillers do not help or things get worse, and also with a weakened immune system, for example during chemotherapy. An ENT referral is made if sinusitis persists after 3 months of treatment, returns again, or symptoms are present only on one side of the face.

At the appointment, the doctor examines the ears, nose, throat and airways. There may be skin allergy tests, blood tests, sputum culture and a throat swab, X-rays of the sinuses and chest. The following signs are checked separately:

• swelling of the forehead, eyes, nasal ala or cheek, blurred vision;
• discharge with an unpleasant odor, from one half of the nose, or not white and not yellow in color;
• cough lasting longer than 10 days or with yellow-green, gray sputum;
• nasal discharge together with a fever.

Nasal congestion by itself is not a reason to call an ambulance; 103/112 — if an infant has developed severe difficulty breathing (respiratory distress) due to nasal congestion.

This material is for reference: it helps you get your bearings, but does not replace a doctor's consultation — the cause of congestion is determined by a doctor at an appointment.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer