Nose Disorders: The Main Diseases and Conditions of the Nose

How the nose works

The nose warms, humidifies and filters every breath. Inside, the septum divides it into two passages. Shelves of bone covered in spongy lining, the turbinates, swell and shrink in a natural cycle that alternates between sides every few hours. A thin layer of mucus traps dust and germs, and tiny hairs (cilia) sweep it to the back of the throat. The sinuses, air spaces in the bones of the face, drain into the nose through small openings. The smell receptors sit high in the roof of the nasal cavity.

Almost every nose disorder interferes with one of these jobs: airflow, mucus clearance, sinus drainage or smell.

The main nose diseases and disorders

Inflammatory and infectious conditions

• Common cold: a viral infection causing a runny nose, sneezing and congestion for 7 to 10 days. See common cold.
• Allergic rhinitis (hay fever): sneezing, itching and a watery nose triggered by pollen, dust mites, mold or pets. See allergic rhinitis.
• Non-allergic rhinitis: a runny or blocked nose triggered by cold air, smells, spicy food, hormones or medicines.
• Rhinitis medicamentosa: rebound congestion from using decongestant sprays for more than a few days.
• Acute sinusitis: blocked sinuses after a cold, with facial pain, thick discharge and congestion for up to 4 weeks. See acute sinusitis.
• Chronic rhinosinusitis: sinus inflammation lasting more than 12 weeks, often with reduced smell. See chronic sinusitis.
• Nasal vestibulitis and boils: infection of the skin just inside the nostril, often from nose-picking or plucking hairs.

Structural problems

• Deviated septum: a septum bent to one side, which can block one nostril and cause snoring. See deviated septum.
• Turbinate hypertrophy: enlarged turbinates causing constant congestion.
• Nasal polyps: soft, painless, grape-like growths of swollen lining, usually on both sides, causing blockage and loss of smell. See nasal polyps.
• Enlarged adenoids in children, causing mouth breathing and snoring.
• Nasal fracture: a broken nose after injury.
• Foreign body: a common problem in young children, causing a smelly discharge from one nostril.

Bleeding

Nosebleeds (epistaxis) are very common. Most start from small vessels at the front of the septum and stop with pressure. Dry air, nose-picking, colds, blood thinners and high blood pressure make them more likely. See epistaxis.

Smell disorders

Loss of smell (anosmia) or reduced smell (hyposmia) commonly follows colds, COVID-19, sinusitis and polyps. Head injury, aging and, rarely, Parkinson's or Alzheimer's disease can also cause it. Distorted smells (parosmia) often occur during recovery. See loss of smell.

Tumors

Growths in the nose and sinuses are uncommon. Benign examples include inverted papilloma. Cancers are rare and are linked to wood dust, leather dust and smoking. Warning signs are a blockage and bloody discharge on one side only, facial numbness, a loose upper tooth or a bulging eye.

Other conditions

• Dry nose, from low humidity, CPAP or Sjogren's syndrome.
• Empty nose syndrome, a rare feeling of blockage despite a wide airway after turbinate surgery.
• Granulomatosis with polyangiitis, a vasculitis that causes crusting, bleeding and a collapsed nasal bridge.
• Cystic fibrosis, which causes thick mucus, polyps and chronic sinusitis.

Symptoms and what they suggest

How nose disorders are diagnosed

• History: how long symptoms have lasted, one side or both, triggers, smell, bleeding, medicines and spray use.
• Anterior rhinoscopy: a look inside the nostrils with a light.
• Nasal endoscopy: a thin camera passed into the nose by an ENT specialist to see polyps, the sinus openings and the back of the nose.
• Allergy tests: skin-prick or blood tests.
• CT of the sinuses: for chronic sinusitis or before surgery.
• Smell tests and, occasionally, MRI.

Treatment options

• Saline sprays and rinses: clear mucus and allergens. Use sterile, distilled or boiled-and-cooled water for rinses.
• Steroid nasal sprays: the most effective treatment for allergic rhinitis, chronic sinusitis and polyps. They take several days to work fully.
• Antihistamines: for allergic symptoms.
• Decongestants: short-term relief only. Sprays for no more than 3 days. Oral decongestants are not suitable for people with high blood pressure or heart disease.
• Antibiotics: only for bacterial sinusitis that is severe, lasts more than 10 days or worsens after improving.
• Biologic medicines: for severe nasal polyps that return despite treatment.
• Surgery: septoplasty for a deviated septum, turbinate reduction, endoscopic sinus surgery, and polyp removal.

Frequently asked questions

What are the most common disorders of the nose?

The most common are the common cold, allergic rhinitis, sinusitis, nosebleeds and a deviated septum. Nasal polyps, non-allergic rhinitis, rebound congestion from decongestant sprays and loss of smell are also frequent. Nasal tumors are rare.

Which nose problems need to see a doctor?

See a doctor for nasal symptoms lasting more than 12 weeks, blockage or bleeding on one side only, loss of smell that persists, frequent nosebleeds, or facial pain with high fever. Get emergency care for heavy bleeding that will not stop or swelling around the eye.

Why is only one side of my nose blocked?

The nasal cycle naturally makes one side feel more blocked at a time. Persistent one-sided blockage usually means a structural problem such as a deviated septum or a polyp. In a child it may be a foreign object. In an adult with bleeding, an ENT specialist should exclude a tumor.

Can nose disorders cause headaches?

Yes. Sinusitis causes pressure and pain over the cheeks, forehead or between the eyes. However, many people who think they have sinus headaches actually have migraine, especially when there is no thick discharge or fever. A doctor can help tell them apart.

Can a nose disorder affect sleep?

Yes. A blocked nose from allergies, polyps, a deviated septum or enlarged adenoids can cause mouth breathing, snoring and broken sleep, and can worsen obstructive sleep apnea. Treating the nasal blockage often improves sleep quality.