Nasal congestion, stuffiness, or obstruction to nasal breathing is one of man’s oldest and most common complaints. While it may be a mere nuisance to some people, to others it is a source of considerable discomfort and detracts from the quality of their lives.

There are four general causes of nasal congestion, but overlap often exists between these causes.


An average adult suffers a common “cold” two to three times per year. The common “cold” is caused by any number of different viruses, some of which are transmitted through the air, but most are transmitted from hand-to-nose contact. Once the virus gets established in the nose, histamine is released which dramatically increases the blood flow to the nose. This causes swelling and congestion of nasal tissues, and the nasal membranes produce excessive amounts of mucus. Antihistamines and decongestants help relieve the symptoms of a “cold,” but time alone cures it.

During a virus infection, the nose has poor resistance against bacteria. This explains why bacterial infections of the nose and sinuses often follow a “cold.” When the nasal mucus turns from clear to yellow or green, it usually means that a bacterial infection has taken over and a physician should be consulted.

Acute sinus infections produce nasal congestion, thick discharge, and pain and tenderness in the cheeks and upper teeth, between and behind the eyes, or above the eyes and in the forehead, depending on which sinuses are involved.

Chronic sinus infections can also cause nasal congestion and also offensive nasal or postnasal discharge. Some persons develop polyps (fleshy growths in the nose) which also leads to a stuffy nose.

Structural Causes

The most common cause of nasal congestion in this category is a deviated nasal septum. The nasal septum is the thin, flat cartilage and bone that separates the nostrils into the right and left sides. These deformities are usually due to an injury at some time in one’s life. The injury may have been many years earlier and may even have been in childhood and long since forgotten. Many newborn infants suffer nasal injury from the natural birth process. Correcting a deviated septum is a minor outpatient surgical procedure.

One of the most common causes for nasal obstruction in children is enlargement of the adenoids. Adenoids are a pad of lymph tissue that fills the back of the nose behind the palate. Children with this problem are snorers and mouth breathers. They sometimes develop a “sad” long face (adenoid facies) and sometimes even have dental deformities. Surgery to remove the adenoids and sometimes the tonsils may be advised.

Other causes of nasal obstruction in this category include nasal tumors and foreign bodies. Children are prone to inserting various objects into their noses. Beware of one-sided foul-smelling discharge, which can be a sign of a foreign body and a physician should be consulted.


Hay fever, rose fever, grass fever, and “summertime colds” are various names for allergic rhinitis. Allergy is an exaggerated inflammatory response to a foreign substance (allergen) which causes the stuffy nose. Common allergens are pollen, mold, animal dander, or house dust. Foods can play a role but is more uncommon. Pollens cause problems in spring (trees) and summer (grasses) or fall (weeds) whereas house dust and mold may be a year-round problem. Ideally the best treatment is avoidance of these substances, but that is impractical in many cases.

In the allergic patient, the release of histamine and similar substances results in congestion and excess production of watery nasal mucus. Antihistamines help relieve the sneezing and runny nose of allergy. Many antihistamines are now available without a prescription. The most familiar brands include Benadryl®, Clarinex®, Claritin®, Allegra®, and Zyrtec.® Decongestants, such as Sudafed® shrink congested nasal tissues. Combinations of antihistamines with decongestants are also available; for example, Actifed®, Allegra D®, Claritin D®. Preparations with the added decongestant have potential side effects and patients should read the package insert. This is especially important if the patient suffers from high blood pressure, glaucoma, irregular heartbeat, prostate problems, or is pregnant.

Allergy shots are the most specific treatment available, and they are highly successful in allergic patients. Skin tests or blood tests are used to determine what the patient is allergic to and how bad the allergy is. Vials are made based upon these allergy test results and injections are given. The strength of the serum in the injections slowly increases and the body forms blocking antibodies which act to “intercept” the allergens when the patient is exposed to these items. Some practices also offer drops which can be placed under the tongue at home. There are pros and cons of each approach and your doctor can discuss these with you.

Vasomotor Rhinitis

”Rhinitis” means inflammation of the nose and nasal membranes. “Vasomotor” means blood vessel. The membranes of the nose have an abundant supply of blood vessels. Normally these blood vessels are in a half-constricted, half-open state. Certain things can alter this balance and lead to the vessels being either too constricted or too open. For example, when a person exercises vigorously, adrenaline hormones constricts blood vessels which thins out the nasal membranes and the air passageway opens up widely.

The opposite takes place when an allergic attack or a ”cold” develops—The blood vessels expand, the membranes become congested (full of excess blood), and the nose becomes stuffy, or blocked.

In addition to allergies and infections, other things can also cause nasal blood vessels to expand, leading to vasomotor rhinitis. These include psychological stress, inadequate thyroid function, pregnancy, certain blood pressure drugs, and overuse or prolonged use of decongesting nasal sprays (Afrin), and irritants such as perfumes or tobacco smoke.

In the early stages of each of these disorders, the nasal stuffiness is temporary and reversible. That is, it will improve if the primary cause is corrected. However, if the condition persists for a long enough period, the blood vessels lose their capacity to constrict. They become somewhat like varicose veins. They fill up when the patient lies down and when he lies on one side, the lower side becomes congested. The congestion often interferes with sleep. So it is helpful for stuffy patients to sleep with the head of the bed elevated two to four inches which can be accomplished by placing a brick or two under each castor of the headboard of the bed.