Nasal Congestion

Anybody with a “runny nose” or “stopped-up nose” may not be allowed in a building without a Covid test. If there are no other symptoms, except perhaps sneezing, Covid is very unlikely. If there are other symptoms, going on for under 2 weeks, see links to those:

โ€ข Fever โ€ข Recent Cough โ€ข Body Aches โ€ข Short of Breath โ€ข Fatigue โ€ข Sore Throat

The rest of this topic assumes it’s not Covid. See also Diagrams — Upper Respiratory System.

Causes of Nasal Congestion or Runny Nose

xxxCommon Diagnoses We Make At First

โ€ข Common Cold (if <2 wks)
โ€ข Allergic Rhinitis (“allergies”) [quite common]
โ€ข Rhinitis Medicamentosa
โ€ข Sore in the Nose (Furuncle) **
โ€ข Perforated / Deviated Nasal Septum **
โ€ข Foreign Body (young children) **
Sinusitis (not as common as people think)x
xxxxxxRarer Conditions  

โ€ข Nasal Polyps
โ€ข Adenoid Enlargement
โ€ข Auto-Immune Diseases

**  Can see it in nose without ENT referral

“ENT” = Ear-Nose-Throat specialist (a.k.a. Otorhinolaryngolgist)

Symptoms Lasting Less Than 2 Weeks

**  Common Cold is far & away the most likely diagnosis (no proven effective treatment available).  We only diagnose another condition if fits a description below:

**  Allergic Rhinitis (“allergies”)  โ†’ try Allergy Medications, helps with Diagnosis if symptoms resolve

  • Very frequent recurrences (every few months); OR
  • Similar symptoms in relatively-recent past that lasted a month or more; OR
  • Lots of sneezing spells

**  Rhinitis Medicamentosa โ†’ see link for Treatment

  • Using daily over-the-counter decongestant sprays for at least 1 week

**  Acute Sinusitis

  • Began as a cold, got lots worse after 1 week
  • Pressure on just one side of face (cheek or forehead), upper teeth on that side hurt when tapped; may have fever too

** Abnormalities Seen Right Inside Front of Nose:

**  Foreign Body in Nose  (Child under 5 yrs-old, lots of mucus in just one nostril)

Symptoms Going On Over 2 Weeks Without Improving at All

**  Allergic Rhinitis (“allergies”) is the most likely diagnosis

  • Especially likely if many sneezing spells, or frequent prior episodes
  • Try Allergy Medications.  If no help in 1 wk, consider other diagnosis:

**  Nasal Polyps (if seen on exam [picture in link]):  Try Allergy Medications for 2 weeks

  • If no help, refer to ENT Specialist

**  Chronic Sinusitis  (if no benefit from Allergy Treatment)

  • Antibiotics for 1 week; if getting better, continue treatment for 3-4 weeks total
  • If antibiotics no help, get sinus CT scan &/or refer to ENT Specialist to diagnose the Rarer Conditions in Table (can be seen with special instrument for endoscopy)

See also Nasal Congestion — Full Text for more in-depth explanations and discussions.

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