Blocked nose: causes, examination and treatment
A blocked nose that lasts for a few days during a cold usually clears up on its own. If the nose remains blocked for weeks or months – at night, on one side or even without any nasal discharge – there is usually an underlying cause that can be identified with an endoscopic examination. At Charlottenlund Private Hospital, persistent nasal blockage is examined and treated by specialists in ear, nose and throat (ENT) conditions at several locations across Denmark.
Blocked nose without discharge – what could it be?
A blocked nose without nasal discharge or a cold makes an infection less likely. The most common explanations are swelling of the lining covering the turbinates, a deviated nasal septum or nasal polyps.
If the blockage switches from one side to the other or improves significantly after using an over-the-counter decongestant nasal spray, the turbinates are often the cause.
If the blockage consistently affects the same side and nasal spray provides little relief, the nasal septum is more likely to be responsible.
If both sides of the nose are blocked and your sense of smell has become reduced, nasal polyps may be the cause.
Why is my nose more blocked at night?
When you lie down, more blood flows to the lining of the nose, causing the turbinates to swell. The nasal lining is naturally dynamic – according to Ugeskrift for Læger, resistance to airflow through the nose changes throughout the day and night. A nose that is just open enough during the day may therefore become completely blocked at night.
This can lead to mouth breathing, snoring, dry mouth and poor sleep. If symptoms are particularly pronounced at night or you experience significant daytime tiredness, you should also be assessed for sleep apnoea.
Can nasal spray cause a blocked nose?
Yes. Over-the-counter decongestant nasal sprays cause the nasal lining to contract and provide rapid relief. However, according to the Danish Rhinological Society, they should not be used for more than 10 days.
If they are used for longer, the nasal lining can become dependent on the spray, causing the nose to become increasingly blocked as soon as the effect wears off. According to Ugeskrift for Læger, this affects 1–7% of patients seen by ENT specialists, and many patients are unaware that the nasal spray itself is causing the problem.
An ENT specialist can help you gradually stop using the decongestant spray and start treatment with a corticosteroid nasal spray instead – a different type of spray that does not cause this dependency.
Blocked nose in children
In young children, a blocked nose accompanied by snoring, mouth breathing and frequent middle ear infections is often caused by enlarged adenoids. Adenoids are lymphatic tissue located behind the nose and are different from the nasal polyps that occur in adults.
Children can be examined at all of the hospital's locations.
How is a blocked nose examined?
The ENT specialist will ask whether the blockage affects one or both sides of the nose, whether it changes sides, when symptoms are worst during the day and what medication or nasal sprays you use.
The nose is then examined using a thin endoscope, both before and after medication is applied to reduce swelling of the nasal lining. This helps determine how much of the blockage is caused by swollen tissue and how much is caused by the nasal septum.
The specialist will also look for nasal polyps and signs of sinusitis. If an allergy is suspected, the examination may be supplemented with allergy testing.
CT scans of the sinuses are not performed at the hospital. Patients are referred for a scan when necessary.
What can be treated without surgery?
Most patients improve without surgery. The basic treatment is daily saline rinsing combined with a corticosteroid nasal spray to reduce swelling of the nasal lining.
If an allergy is present, it is treated, and excessive use of over-the-counter decongestant nasal spray is gradually stopped.
If medical treatment has not already been tried, it can be started and monitored at Charlottenlund Private Hospital. Surgery is considered only if medical treatment does not provide sufficient improvement in nasal airflow.
What operations can help with a blocked nose?
The right operation depends on the cause. A deviated septum is corrected with septoplasty. Enlarged nasal turbinates are reduced with a conchotomy. Chronic sinusitis is treated by opening the sinuses with endoscopic surgery, and nasal polyps are removed during the same procedure. If the outside of the nose is crooked, functional rhinoplasty may be considered. Several procedures can often be combined under the same anaesthetic. All operations are performed under general anaesthesia in the operating theatre in Charlottenlund, and patients usually go home the same day.
When should you seek medical advice for a blocked nose?
A nose that has been blocked for several weeks without a cold should be examined by an ENT specialist—especially if it disrupts your sleep or you can only keep it clear with daily over-the-counter nasal spray. If you also have discharge, facial pressure or a reduced sense of smell for more than 12 weeks, you may have chronic sinusitis. A blocked nose on one side only, with bloody discharge, should always be checked. Swelling around the eye, double vision, a high fever or a severe headache along with a blocked nose requires urgent medical attention.
Your care at Charlottenlund Privathospital
Your care starts with an initial consultation with an ENT specialist—in Charlottenlund or at one of the hospital’s other locations. The cause is identified and a plan is made: medical treatment, gradually stopping nasal spray, allergy testing, or surgery. Follow-up appointments can take place at the location closest to you. If surgery is needed, it is performed in Charlottenlund.
Read more about examinations with the hospital's ENT specialists.
Frequently asked questions
Why is my nose always blocked?
A nose blocked for several weeks without a cold is most often caused by swollen nasal lining due to allergies or chronic sinusitis, enlarged nasal turbinates, nasal polyps, a deviated septum, or overuse of over-the-counter nasal sprays. The cause can be identified with an endoscopic examination.
What does a blocked nose without nasal discharge mean?
It means the blockage is not caused by an infection. It is usually due to enlarged nasal turbinates, a deviated septum or nasal polyps.
Why is my nose most blocked at night?
When you lie down, more blood flows to the nasal lining, and the turbinates swell. A nose that is open enough during the day may therefore become blocked at night.
How long can you use a decongestant nasal spray?
Over-the-counter nasal decongestant sprays should not be used for more than 10 days. With prolonged use, the nasal lining becomes reliant on the spray and the nose becomes more congested.
Can a blocked nose be treated with surgery?
Yes, when the cause is a deviated septum, enlarged nasal turbinates, nasal polyps with chronic sinusitis, or a crooked outer nose—and when medical treatment has not helped enough.
When should you see a doctor about a blocked nose?
When your nose has been blocked for several weeks without a cold, is disrupting your sleep, or can only be kept clear with daily nasal spray. A blocked nose on one side only, with bloody discharge, should always be checked.