How Can I Clear Congestion? What to Know About Treatment and Causes

Dec 22, 2023

Ask Well

Seasonal allergies, pet dander, temperature changes and sinus infections are just a few potential triggers for this common problem. Here’s what experts say can help.

Credit...Joyce Lee for The New York Times

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By Dani Blum

Q: What is the best way to treat chronic congestion?

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, said 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.

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, Dr. Dykewicz added. 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-center. That makes one nasal passage larger than the other, Dr. Dykewicz said, 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, he added.

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, too, said 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 like perfumes, car exhaust and cigarette smoke can cause our noses to react, Dr. Dykewicz added.

Viral infections like the common cold, flu and Covid-19 can also lead to congestion, as can viral pneumonia. Other factors include temperature and humidity changes, Dr. Dykewicz said, though 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, Dr. Hochman said, 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), Dr. Hochman said, 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, Dr. Dykewicz said. 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.

It may sound simple, but first try clearing out your nose as much as possible by gently blowing into a tissue, said 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, Dr. Dykewicz said. 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, Dr. Hochman said.

Certain over-the-counter medications may help combat congestion, although many come with caveats, Dr. Dykewicz said.

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, Dr. Hochman said, 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, Dr. Dykewicz added. Steroid nasal sprays that contain active ingredients like fluticasone (Flonase), triamcinolone (Nasacort) or budesonide are safe to use for as long as you need them, Dr. Sindwani said. “No problem, you can use those ad infinitum,” he said.

But nasal sprays that contain decongestants like oxymetazoline (Afrin) or phenylephrine (Neo-Synephrine) should be used for no longer than three to five days, or you risk what doctors call “rebound congestion,” Dr. Dykewicz said. 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, Dr. Hochman said, 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, Dr. Dykewicz said.

“The nose gets stuffier and stuffier,” Dr. Dykewicz said. “People become de facto addicted to it.”

If chronic congestion is interfering with your daily life, Dr. Hochman said, 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 said.

Dani Blum is a reporter for Well. More about Dani Blum

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