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:

• Fever • Recent Cough • Body Aches • Short of Breath • Fatigue • 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 • Common Cold (if <2 wks) • Allergic Rhinitis (“allergies”) [quite common] • Rhinitis Medicamentosa • Sore in the Nose (Furuncle) ** • Perforated / Deviated Nasal Septum ** • Foreign Body (young children) ** • Sinusitis (not as common as people think)x x

xxxxxxRarer Conditions   • Nasal Polyps • Adenoid Enlargement • Auto-Immune Diseases • Tumors     **  Can see it in nose without ENT referral x

“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”)  → 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 → 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:

• Sores / Boils (Furuncles) / Perforated Nasal Septum / Deviated Nasal Septum

**  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.