Blocked Nose

1. A structural problem such as a deviated septum of the nose, nasal polyps, the adenoid gland and more rarely growths or foreign bodies, may cause a blocked nose. In this setting, the nose is usually blocked most of the time and on one side predominantly.

2. Swelling of the lining of the nose may also cause a blocked nose. Such swelling may be associated with allergies or sinus inflammation (acute and chronic sinusitis) but can also occur in the absence of allergies such as due to the side effects of certain medicines including nasal decongestants. In the case of allergies, people often experience that their nasal blockage switches between the two sides and worsens at night when they lie down.

1. The main initial management is reduction of allergen exposure (or desensitisation therapy if allergies exist) and medical treatment (usually nasal sprays) as well as saline rinses. These can be nasal decongestants but note that they should not be used for more than a few days as they can cause congestion in the nose. For longer term control, nasal steroid sprays can be effective if used regularly. These are safe to use and are similar to asthma inhalers. There are also sprays that have antihistamines combined with them which mean that the need for oral antihistamines is reduced.

2. If nasal blockage is troublesome and not controlled by medical treatments, then surgery on the nose may help. This is via a septoplasty, turbinoplasty or septorhinoplasty (nose job) for more complex cases involving a septal deviation and sinus surgery for polyps and other sinus conditions.

The inside of the nose has swellings called turbinates that run along the side of the nose wall. These turbinates have a lining that has many blood vessels. When we lie down, these blood vessels fill up and people may feel congested. This sensation can worsen when people turn over in bed as the nostril on the lower side fills more and causes more obstruction.

A blocked nose does not typically cause headaches. However, in some individuals with a migraine background, it is possible that the nasal blockage may be triggering the migraine.

A septal perforation can potentially contribute to a blocked nose, although it is not a direct cause. A septal perforation is a hole that forms in the nasal septum, which is the cartilage and bone structure dividing the nostrils. This condition can result from various factors, including trauma, chronic use of nasal drugs such as cocaine, or underlying diseases.

When a perforation occurs, it can disrupt airflow through the nasal passages, leading to symptoms such as nasal obstruction or a sensation of a blocked nose. Additionally, the presence of the perforation can make the nasal mucosa more susceptible to irritation and inflammation, which can also contribute to feelings of congestion.

Individuals with a septal perforation may experience other complications, including recurrent nosebleeds, crusting, and, in some cases, infections. These factors may exacerbate the sensation of nasal blockage.

Surgical closure is the preferred treatment option to resolve the above issues and modern knowledge and techniques mean that success rates are significantly improved; even for larger perforations