What causes persistent nasal blockage?

A nose that stays blocked after a cold has passed can have several causes. Allergies can swell the lining of the nose. Nasal polyps or a bend in the wall between the nostrils can leave less room for air to pass. One useful detail to notice is whether the same side always feels blocked.

Why does the blocked side switch, especially at night?

Suppose your left nostril feels stuffy when you go to bed, but by morning the right one feels tighter. The soft lining inside the nose naturally swells a little on one side while it shrinks on the other. A few hours later, the sides can switch. This is called the nasal cycle. Most of the time you barely notice it.

Lying on your side can make the nostril nearer the pillow feel stuffier. A cold or allergy can make the difference more obvious, too. Notice whether the stuffiness eases after you get up. An occasional change of sides is different from one nostril that never seems to clear. If congestion regularly interrupts your sleep, mention it at your appointment even if the blocked side changes.

What if the same nostril always feels blocked?

A deviated nasal septum occurs when the thin wall dividing your nostrils is off-centre. This can make one nasal passage smaller than the other. But a blockage on one side does not, by itself, tell you that your septum is the cause. If one side stays blocked, especially if this is new or you also have nosebleeds or blood-stained mucus, arrange a medical assessment promptly. These symptoms often have a common cause, but they need an examination. Read the NHS guidance on persistent one-sided symptoms.

What else happens when your nose feels blocked?

• Sneezing, itching or watery eyes: If these flare up when you dust a room or spend time around an animal, mention the pattern. With allergic rhinitis, the lining of the nose swells after contact with a trigger.
• Food seems less fragrant: A reduced sense of smell alongside stuffiness can occur with nasal polyps. These are soft, non-cancerous growths inside the nose or sinuses. An examination can help distinguish them from other causes.
• Pressure in your cheeks or forehead: If you also have nasal discharge or a reduced sense of smell, tell the doctor how long the symptoms have lasted. Chronic sinusitis is inflammation of the sinuses lasting at least 12 weeks. You do not need to wait 12 weeks to seek help.

What should you tell the ENT doctor?

If the blockage has continued for a few weeks without improving, or it regularly wakes you at night, book a visit. Before you go, jot down when it started, which side is affected and whether anything makes it better. Bring the names of any nasal sprays you use and say how often you use them. Some decongestant sprays can make stuffiness worse when used for too long.

The doctor can examine the inside of your nose and, if needed, use a thin scope to see farther back. The next step depends on what the examination shows.

Does a blocked nose mean I need surgery?

Usually, the first question is what is taking up space inside the nose. If the lining is swollen because of an allergy, the doctor may suggest treating the inflammation. If the examination shows nasal polyps, a prescribed steroid spray or drops may shrink them. Surgery is one option if treatment does not give enough relief.

A bent septum is a different issue: a spray can reduce swelling around it, but cannot straighten it. Even then, finding a bend does not automatically mean you need an operation. Ask the ENT doctor: “Does the bend explain the side that feels blocked? What could I try first, and how will we know if it has helped?”

If you would like an assessment in Varanasi, you can request an appointment at Satkriti Hospital or read about its nose and sinus services.

Further reading: NHS Cornwall: causes of nasal congestion and obstruction; NHS: nasal polyps.