SymptomEar, nose & throat
Nasal Congestion (Stuffy Nose)
Nasal congestion is a blocked or stuffy feeling in the nose caused by swollen blood vessels and tissue in the nasal lining, often with extra mucus. The most common causes are colds, allergies and sinusitis, and most congestion clears within 1 to 2 weeks. Congestion that lasts more than 12 weeks, affects only one side, or comes with nosebleeds, facial swelling or loss of smell may be due to a deviated septum, nasal polyps or, rarely, a growth and should be checked.
Also called: Stuffy nose, blocked nose, nasal obstruction, nasal stuffiness, stuffed-up nose
At a glance
- What it is
- A blocked or stuffy nose from swollen nasal lining, with or without mucus.
- Common causes
- Colds, allergies, sinusitis, pregnancy, overused decongestant sprays.
- Long-term or one-sided causes
- Deviated septum, nasal polyps, enlarged adenoids in children, an object in the nose.
- Typical duration
- 7 to 10 days with a cold; weeks to months with allergies or chronic sinusitis.
- Diagnosis
- Usually from symptoms; nasal endoscopy or CT for persistent congestion.
- Main treatments
- Saline rinses, steroid nasal sprays, short-term decongestants, antihistamines for allergies.
When to get help
Call 911 or go to the ER
- Swelling or redness around one eye, double vision, or eye pain with a blocked nose and fever
- Severe headache, stiff neck, confusion or drowsiness with sinus symptoms
- A baby who cannot feed or is struggling to breathe because of a blocked nose
See a doctor within a day or two
- Fever over 39 °C (102.2 °F) with severe facial pain or swelling
- Symptoms that improve and then get worse again (possible bacterial sinusitis)
- A blocked nose after a facial injury with a swollen, crooked or very painful nose
- Foul-smelling discharge from one nostril in a young child (possible object in the nose)
Book a routine appointment
- Congestion lasting more than 10 days without improvement, or more than 12 weeks in total
- Congestion on one side only that does not go away, especially with nosebleeds, crusting or facial numbness
- Loss of smell that lasts more than a few weeks
- Snoring, mouth breathing and poor sleep in a child
- Needing a decongestant spray every day to breathe through your nose
Usually safe to manage at home
- A stuffy nose with sneezing and a mild sore throat from a cold
- Seasonal congestion with itchy eyes that responds to allergy treatment
What causes a stuffy nose
Congestion is mainly caused by swelling, not mucus. The inside of the nose contains spongy tissue (the turbinates) full of blood vessels that swell when irritated by viruses, allergens or chemicals. This is why blowing your nose does not always clear it.
It is normal for the nose to alternate between sides every few hours as one side swells and the other shrinks (the nasal cycle). Most people only notice this when congested.
Common causes of nasal congestion
Colds and flu
A viral infection is the most common cause. Congestion builds over 2 to 3 days with sneezing, a runny nose (coryza) and a sore throat, and clears within 7 to 10 days. See common cold.
Allergic rhinitis
Pollen, dust mites, pet dander and mold trigger swelling and clear discharge, with sneezing and itchy eyes, nose and throat. It may be seasonal (hay fever) or year-round. See allergic rhinitis.
Sinusitis
Inflammation of the sinuses causes congestion with thick discolored mucus, facial pressure and reduced smell. Acute sinusitis follows a cold; chronic sinusitis lasts 12 weeks or more. See sinusitis.
Non-allergic rhinitis
Congestion and dripping triggered by cold air, strong smells, smoke, alcohol, spicy food or weather changes, without allergy.
Overuse of decongestant sprays
Using oxymetazoline or similar sprays for more than 3 days causes rebound swelling, so the nose becomes more blocked and the spray is needed again. This is rhinitis medicamentosa.
Pregnancy and hormones
Higher estrogen and blood volume cause pregnancy rhinitis, especially in the second and third trimesters. It resolves within 2 weeks after delivery. Hypothyroidism and some contraceptives can also cause congestion.
Medicines
Some blood pressure medicines (such as beta-blockers and alpha-blockers), erectile dysfunction medicines, some antidepressants and NSAIDs in sensitive people can block the nose.
Congestion on one side of the nose
Persistent one-sided blockage suggests a structural cause:
| Cause | Clues |
|---|---|
| Deviated septum | Long-standing, often after a nose injury, worse on one side |
| Nasal polyps | Gradual blockage, loss of smell, often both sides, with asthma |
| Foreign object | Young child, foul smell and discharge from one side |
| Enlarged turbinate | Alternating or one-sided blockage |
| Nasal tumor (rare) | One side, blood-stained discharge, crusting, facial numbness or swelling |
Stuffy nose at night
Congestion often worsens at night because lying down increases blood flow to the nasal lining and mucus pools. Dust mites in bedding, dry indoor air and reflux also contribute. Raising the head of the bed, using a humidifier, washing bedding in hot water and using an allergy-proof mattress cover can help. Long-term night-time blockage causes snoring, mouth breathing and poor sleep.
Nasal congestion in babies and children
Babies breathe mainly through their noses, so congestion can make feeding difficult. Saline drops and gentle suction before feeds are safe and effective. Do not give cough and cold medicines to children under 6. In children, chronic congestion with snoring and mouth breathing is often due to enlarged adenoids.
How the cause is found
A doctor will ask how long the congestion has lasted, whether it is one or both sides, about triggers, smell, sprays used and other symptoms. They look inside the nose with a light. For congestion lasting more than 12 weeks, or one-sided symptoms, an ENT specialist may use a thin camera (nasal endoscopy) and arrange a CT scan of the sinuses. Allergy skin or blood tests identify triggers.
Nasal congestion relief
Home remedies that work
- Saline spray or rinse: salt water rinses out mucus and allergens and reduces swelling. Use sterile, distilled or previously boiled water for rinse bottles and neti pots, never plain tap water.
- Humidify the air, especially in winter, and breathe steam from a shower.
- Raise your head on an extra pillow at night.
- Stay hydrated to keep mucus thin.
- Nasal strips open the front of the nose and can improve airflow at night.
Medicines
| Medicine | Best for | Notes |
|---|---|---|
| Steroid nasal sprays (fluticasone, budesonide, mometasone) | Allergies, chronic sinusitis, polyps | Most effective long-term option; takes several days to work fully; use daily |
| Decongestant sprays (oxymetazoline) | Short-term relief, colds | No more than 3 days to avoid rebound congestion |
| Oral pseudoephedrine | Colds, short-term | Kept behind the pharmacy counter in the US; avoid with high blood pressure, heart disease, glaucoma, an enlarged prostate or in young children |
| Oral phenylephrine | Not recommended | The FDA has concluded that oral phenylephrine does not work as a decongestant |
| Antihistamines | Allergies | Help sneezing and dripping more than blockage; antihistamine nasal sprays also available |
| Ipratropium nasal spray | Dripping nose | Reduces runny nose, not blockage |
Follow the label dose for all over-the-counter medicines.
Medical and surgical treatment
- Antibiotics only for bacterial sinusitis that meets specific criteria.
- Allergen immunotherapy (shots or tablets under the tongue) for persistent allergies.
- Stopping rebound sprays, usually with a steroid spray to help the transition.
- Surgery: septoplasty for a deviated septum, turbinate reduction, polyp removal or sinus surgery, and adenoid removal in children.
Frequently asked questions
What is the fastest way to relieve a stuffy nose?
A decongestant nasal spray such as oxymetazoline works within minutes but should be used for no more than 3 days. Saline rinses, steam and raising your head also help quickly. For allergies, a daily steroid nasal spray gives the best lasting relief.
Why is only one side of my nose blocked?
Short-term one-sided blockage is often the normal nasal cycle made noticeable by a cold. Persistent one-sided blockage suggests a deviated septum, a polyp or, in children, an object in the nose. One-sided blockage with bleeding or crusting should be checked by a doctor.
How long does nasal congestion last?
With a cold, congestion usually clears within 7 to 10 days. Allergic congestion lasts as long as you are exposed to the trigger. Congestion lasting more than 12 weeks is considered chronic and should be assessed for sinusitis, polyps or structural problems.
Why is my nose more blocked at night?
Lying flat increases blood flow to the nasal lining and lets mucus collect. Dust mites in bedding, dry air and reflux add to it. Raising your head, using a humidifier, saline before bed and allergy-proofing the bedroom can help.
Can nasal sprays make congestion worse?
Yes. Decongestant sprays such as oxymetazoline used for more than about 3 days can cause rebound congestion, making the nose more blocked when the spray wears off. Steroid and saline sprays do not cause this and are safe for long-term use.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Otolaryngology-Head and Neck Surgery: Clinical practice guideline, allergic rhinitis; Adult sinusitis
- MedlinePlus: Stuffy or runny nose, adult
- NHS: Sinusitis
- American Academy of Allergy, Asthma and Immunology: Rhinitis
- US Food and Drug Administration: Oral phenylephrine as a nasal decongestant