6 Common Causes of Congestion
Congestion makes you feel like you can’t breathe in easily through the nose. It also makes the area of your face around your nose and eyes feel full and stuffed up.
Congestion can be the symptom of a lot of different conditions, but usually, it’s from allergies or another cause of inflammation (often from an infection). Bacteria or viruses can infect the lining of your nose or sinuses (the hollow areas in the bones of your face). When this area becomes inflamed, your mucosa (the lining of the inner nose) swells and can cause congestion.
Infection of the sinuses can make it harder for the sinuses to drain mucus and cause a feeling of fullness or pain in the face.
Congestion can often be temporarily treated with saline rinses or taking an over-the-counter decongestant, but sometimes underlying causes need to be addressed.
1. Common cold
- Runny nose
- Sore or itchy throat
The common cold is a viral infection of the upper respiratory tract, which includes the nose, mouth, sinuses, throat, and larynx. There are over 200 viruses that can cause a cold, and usually the exact virus behind a cold is never known. Colds usually get better on their own, but you can take decongestants to help relieve your stuffy nose.
2. Influenza (flu)
Symptoms can vary from more minor cold symptoms to fevers, not eating, weakness, and severe fatigue.
Influenza, or "the flu," is a contagious respiratory illness caused by influenza viruses. It is spread through the air by coughing, sneezing, or even talking. It is also spread by touching contaminated surfaces and touching your face. Anyone can get the flu, but people who are very young, over 65, or have pre-existing medical conditions are most at risk for serious complications.
There are antiviral medications a doctor can prescribe for people with a high risk of complications. But treatment mostly consists of resting, drinking a lot of fluids, and if needed, taking over-the-counter pain medications like acetaminophen for fever, sore throat, or body aches. Do not give aspirin to children.
3. Allergic rhinitis
Chronic (longstanding) congestion can be from a few different causes. Ask your doctor if you should see a specialist such as an otolaryngologist (Ear, Nose, and Throat doctor) or an allergist? —Dr. Benjamin Ranard
- Runny nose
- Nose or eye itching
- Mucus dripping from nose down back of throat
Allergic rhinitis occurs when you have an allergy to something in the environment. Seasonal allergies are generally caused by pollen, grass, and weeds, and are worse during a certain time of the year. Allergies that are more constant are from allergens you are constantly exposed to such as dust mites, molds, and animal dander.
Allergies commonly begin in childhood but they can start at any age. They are more common if you have a family history of allergic diseases. They can usually be managed with allergy medications and reducing exposure to the allergens when possible.
4. Acute rhinosinusitis (sinus infection)
- Facial pain or pressure, often worse when bending forward
- Discomfort in the upper teeth
- Drainage of dark green or yellow mucus from nose
- Can also have fever, cough decreased sense of smell, ear fullness, hearing change, ringing in ears, bad breath, headache
Acute rhinosinusitis or "sinus infection," happens when viruses or bacteria infect the sinuses (the spaces in the bone under the face). It is usually caused by the same viruses that cause the common cold. Infections from viruses and bacteria can be hard to distinguish.
Typically if the infection is less than 7 to 10 days, it’s probably viral and no antibiotics are required. Longer infections or infections that start to improve and then become much worse may be caused by a bacteria. These should generally be treated with antibiotics.
5. Chronic sinusitis
A common misconception is that: “If I have a stuffy nose and facial pain then I must have a sinus infection.” While sinus infections can certainly result in a stuffed nose and facial pain, allergies, nasal polyps, a deviated nasal septum, and other medical conditions can also lead to chronic congestion symptoms. —Dr. Ranard
- Facial pressure, fullness, or pain
- Yellow/green mucus draining from nose or down back of throat
- Reduced smell
- Other symptoms may include cough, fatigue, ear pain or fullness, dental pain (mainly top teeth), hoarse voice, throat irritation
Chronic sinusitis is an ongoing inflammation of the sinuses (the spaces in the bone under the face). It’s a form of sinusitis diagnosed when the nasal passages stay inflamed for 12 weeks or longer.
The condition may start with an acute sinusitis (viral or bacterial) infection and later develop into a chronic infection. Allergies, aspirin-related respiratory diseases, or underlying structural issues may also cause chronic sinusitis.
6. Non-allergic rhinitis
- Postnasal drip (mucus draining down back of throat)
- Runny nose
- Nasal congestion
Rhinitis means "inflammation of the nose." When it is caused by something other than allergies, infections, or medications, it is often called non-allergic. There are many causes of non-allergic rhinitis. Some people have an abnormal response to odors, cold, spicy food that can trigger inflammation in the nose.
Compared to allergic rhinitis, patients with non-allergic rhinitis are more likely to have post-nasal drip and less likely to have sneezing and eye symptoms. Patients with allergic rhinitis are more likely to be able to identify certain allergic triggers or times of year when symptoms are worse.
Non-allergic rhinitis is less likely to respond to medical therapy, but there are nasal medications like nasal steroids and nasal antihistamine.
Other possible causes
Other more rare causes of congestion include: workplace exposures, frequent use of certain nasal decongestants, pregnancy, congestion after repeated sinus surgery, anatomic reasons (i.e., septum deviation), and a variety of systemic diseases.
When to call the doctor
- New congestion lasting more than 1 to 2 weeks
- Congestion with fever
- Symptoms of rhinosinusitis lasting more than 7 to 10 days or that have improved and then become worse again
- Longstanding congestion should be evaluated
Should I go to the ER for congestion?
Most cases of congestion can be treated at home or by your doctor. If you have a foreign body in your nose, you need to see your doctor to have the foreign body removed.
A “Neti pot” is actually from an ancient yoga tradition to prepare for meditation. It can be an effective treatment for congestion but a bit of a hassle and messy. There are now a variety of products available for nasal irrigation—some are easier to use. Just remember to always follow the package directions and never use untreated tap water. —Dr. Ranard
- Saline rinses may help your congestion. Two common brands are NeilMed and Navage. Be sure to follow the directions carefully, including not using untreated tap water.
- Avoid known allergens, smoke inhalation, and other triggers.
- Decongestants: there are several over-the-counter decongestants. Many of them can cause rebound congestion if used for more than a few days. Read the instructions on the box.
- Pain medication: Over-the-counter pain medications like acetaminophen (Tylenol) or ibuprofen (Advil) can be taken for facial pain or headaches.
- Allergy medicine: Over-the-counter allergy medicines can be taken for congestion caused by allergies.
Other treatment options
- Nasal spray medications: Steroid and antihistamine nasal sprays may be prescribed by your doctor depending on the underlying cause of congestion.
- Allergy medications taken by mouth may be prescribed.
- Allergy testing can help identify the cause of allergic congestion. Sometimes allergy shots can be given to decrease allergic causes of congestion.
- An evaluation by an ear, nose, and throat surgeon (ENT or otolaryngologist) may be required if there are underlying anatomic issues. That could lead to a surgical procedure to correct the issue.
Dr. Ranard is a Pulmonary and Critical Care fellow at Columbia University Irving Medical Center / NewYork-Presbyterian Hospital. He received his undergraduate degree in Biological Sciences from Cornell University (2011) and his Doctor of Medicine and Masters of Science in Health Policy Research from the University of Pennsylvania Perelman School of Medicine (2016). In addition to pulmonology and critical care medicine, Dr. Ranard is interested in health care redesign, health policy, and looking for ways to improve the quality of care for all patients.