Senior Health

1/16/2024 | By Howard LeWine, M.D.

If you have a persistent stuffed nose that just won’t get better, what could be causing it? More important, can anything be done to help? Dr. Howard LeWine of Harvard Health Publishing addresses this persistent problem.

Question: My nose constantly feels congested, especially on the right side. I don’t have any other symptoms. What might be causing it?

Answer: The nasal block you feel is likely due to a chronic condition or obstruction that’s reducing the amount of air passing through your nose.

Allergies or a chronic sinus problem might be the cause. The insides of your nose and sinuses are lined with a layer of sensitive tissue called the mucosa. They can become chronically inflamed, usually by allergies, reducing the space left for air flow.

Potential structural issues leading to nasal obstruction include:

  • Enlarged turbinates. The turbinates are structures inside the nose that warm and filter air as it passes. Environmental irritants (such as smoke), hormone changes, and allergies and chronic sinus problems can inflame the mucosa lining the turbinates: as they swell up, the nasal passages narrow.
  • Nasal valve compromise. That’s a fancy name describing a structural narrowing in certain areas of the nasal passages. It can occur as the result of injury, the nasal structure you were born with, nose surgery, or simply aging.
  • A deviated septum. The septum is the wall dividing the left and right sides of the nose. You might have been born with a crooked septum, or it might have become misshapen in an accident. And a deviated septum that was never a problem before can cause symptoms if there’s also nasal valve compromise and a loss of support tissues.
  • Nasal polyps. These noncancerous (benign) tumors grow along mucosa or sinuses and can block airflow.
A man at a doctor's appointment. By Mark Adams

The cause of nasal obstruction won’t be as plain as the nose on your face. You’ll probably need to see an ear, nose, and throat specialist (ENT), also called an otolaryngologist, to figure out what the problem is.

The ENT will ask about your medical history and the symptoms you’re experiencing, and then look inside your nose to see what’s blocking airflow. The specialist might also order allergy testing.

Finding relief for your persistent stuffed nose

Strategies to reclaim real estate in your nasal passages depend on the cause of obstruction. If you have allergies, sinus problems, or enlarged turbinates, your doctor can prescribe a steroid nasal spray or other medications to tame inflammation. If the turbinates don’t shrink with nasal sprays, you may need an office procedure or surgery to reduce them.

For passageways narrowed from nasal valve compromise, the doctor may first recommend some non-invasive therapies, starting with a trial of a steroid nasal spray. You can also try to open the nasal passages by using nasal dilators — either an adhesive strip you wear on the nose to gently pull the passages apart, or small cone-shaped devices that you insert into the nostrils.

The only way to straighten a deviated septum is with a surgery called a septoplasty.

Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.

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Howard LeWine, M.D.

Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.