Nasal congestion or nasal obstruction is a very
common complaint patients have when presenting to a doctor’s office.
It does not hurt, but it sure can be very annoying when having to mouth-breath often,
especially when it persists for weeks to months and does not seem related to any obvious illness.
So what are some of the common as well as uncommon causes of a persistent clogged and obstructed
nose that just won’t open up? Some reasons may be obvious, but others may be quite unusual. So here
are the top 7 causes of a clogged or obstructed nose from the most obvious to the more unusual.
Keep in mind that treatment for some of these causes can be found in the video description box.
Most people would automatically assume this common cause for a clogged nose.
When allergic substances enter the nose, it can cause the sino-nasal lining to swell
leading to symptoms. Although most will try to address allergies at home with
over-the-counter medications, if it gets bad enough without improvement, it may need
to be professionally evaluated with allergy testing along with prescription medications.
If no allergies are present, anatomic issues may be what is causing a nasal obstruction.
Normally, the nasal septum is a wall that equally separates the left and right nasal cavities.
However, the septum may be deviated to one and sometimes even both sides resulting
in nasal breathing difficulties. Here, the septal deviation is denoted by the
green arrow. Here is what a normal straight septum should look like.
Another anatomic problem may be large inferior turbinates.
Inferior turbinates are present in all individuals and are located on the sides of the nasal cavity
as shown here. Normally, the inferior turbinates are small and aid in warming and humidifying the
air inhaled into the nasal passages. However, these turbinates can become enlarged leading
to nasal clogging and even obstruction if they get big enough. The turbinates can
also fluctuate in size causing the nasal symptoms to also fluctuate in severity.
Especially in children, but sometimes even in adults, the adenoids located in the very back
of the nose highlighted in blue can be quite large resulting in nasal clogging.
One can see the difference in how much more open the nasal
cavity would become when the adenoids are removed or insignificant in size.
Nasal polyps are a more rare anatomic cause for nasal clogging and even obstruction if they
become very large as shown here. One can consider nasal polyps to be a type nasal mucosal blistering
often triggered by uncontrolled allergic factors. Here is a normal CT Sinus scan. For comparison,
here is a CT Sinus scan of a patient with severe nasal polyps.
Although some may consider a narrow nasal profile to be attractive,
this type of nasal profile can also lead to a more narrow nasal
passageway leading to persistent issues with nasal breathing difficulties.
Finally, decongestant nasal sprays can trigger a persistently clogged and even obstructed nose.
Initially, these over-the-counter nasal sprays which often contain the active
ingredient oxymetazoline, phenylephrine, or neosynephrine can help with such symptoms.
But if one uses these nasal sprays for more than 3 days, these nasal sprays
can potentially cause and/or aggravate nasal clogging. Patients essentially become addicted
to these nasal sprays and over time, often need to use it more frequently for relief.
So there you have it. Although most clogged nasal issues can be addressed by your primary
care doctor, you may end up having to see specialists to ultimately resolve a persistent
nasal obstruction. Such specialists include an ENT and an allergist.