Blocked Nose: Why It Happens and What Can Actually Be Done About It
- 8 hours ago
- 4 min read
Written by Mr Tim Biggs | Consultant ENT Surgeon | Rhinology & Facial Plastics
Why a Blocked Nose Deserves Proper Assessment
Nasal obstruction affects millions of people in the UK, yet it is one of the most undertreated symptoms in general practice. Many patients are given a nasal steroid spray, told to wait, and not seen again. When symptoms persist, the assumption is often that the spray has been ineffective and nothing further can be done.
The reality is that a persistently blocked nose almost always has an identifiable cause, and in many cases a very effective treatment. The key is matching the treatment to the correct underlying diagnosis, which requires a proper assessment including nasal endoscopy.
The Main Causes of Persistent Nasal Obstruction
The nasal septum is the central partition dividing the nose into two sides. A deviation, whether congenital or from previous trauma, can narrow one or both nasal passages significantly. Septoplasty, performed under general anaesthetic through the nostrils with no visible scarring, corrects the deviation and restores the nasal airway. It is one of the most reliably effective operations in ENT surgery when performed for the right indication.
The inferior turbinates are scroll-shaped structures lining the inside of the nose. When chronically enlarged due to rhinitis, allergy, or compensatory changes from septal deviation, they occupy a significant portion of the nasal airway. Submucosal microdebrider turbinoplasty reduces their bulk while preserving mucosal function, and is often combined with septoplasty for the best result.
Nasal Polyps
Nasal polyps are benign inflammatory growths arising from the sinus lining that can expand progressively into the nasal airway, causing severe obstruction and loss of smell. They require a combination of medical treatment, including nasal steroid drops and, in severe cases, biologic therapy such as dupilumab, and surgical removal via FESS when medication is insufficient.
Chronic Sinusitis
Chronic mucosal thickening in the sinuses and the nasal drainage area can contribute to a persistent feeling of congestion and obstruction that is not simply a blocked nose in the structural sense, but reflects ongoing sinonasal inflammation. FESS restores sinus ventilation and drainage and addresses the inflammatory component.
Allergic and Non-Allergic Rhinitis
Rhinitis, both allergic and non-allergic, causes mucosal swelling and increased secretion that contributes to nasal obstruction. Nasal steroid sprays are highly effective when used correctly and consistently, and are the appropriate first-line treatment. Allergy testing, antihistamines, and allergen immunotherapy may be indicated for significant allergic rhinitis.
The nasal valve, the narrowest part of the nasal airway located at the junction of the upper and lower lateral cartilages, is an important but frequently missed cause of nasal obstruction. When the supporting cartilage is weak or has been compromised, the nasal sidewall collapses inward on inspiration, obstructing airflow. Patients typically notice the blockage worsens when breathing in forcefully and is relieved by pressing outward on the cheek with a finger (Cottle's test).
Nasal valve collapse requires a structural surgical approach. Spreader grafts, batten grafts, or suspension sutures, all techniques from structural rhinoplasty, are used to support the valve and maintain patency on inspiration. This is a procedure I perform regularly at Adnova Clinic, where the full range of structural nasal surgery is available.
Adenoid Hypertrophy
In children and occasionally adults, enlarged adenoids in the nasopharynx can block nasal airflow, causing mouth breathing, snoring, and a persistently blocked nose. Adenoidectomy is a simple and effective treatment.
When Nasal Sprays Are Not Enough
Nasal steroid sprays are genuinely effective for rhinitis-related turbinate swelling and for smaller nasal polyps. However, they do not correct structural abnormalities such as a deviated septum, bony turbinate hypertrophy, or nasal valve collapse. Expecting a spray to fix a structural problem leads to the frustrating cycle of prescribed-but-ineffective treatments that many patients experience for years before seeking specialist assessment.
A nasal endoscopy, which takes only a few minutes in clinic, will identify whether your obstruction is structural, inflammatory, or both, and allows a genuinely tailored treatment plan.
Arrange a Consultation
If you have a persistently blocked nose that is affecting your sleep, exercise, or day-to-day quality of life and has not responded adequately to treatment, I would be glad to assess you. A clear diagnosis is the starting point for effective treatment.
I see patients privately at Medicana Hospital in Winchester and Adnova Clinic in Fareham. Contact my secretary Michele Hewlett to book. Fees are available at www.hampshireentclinics.co.uk.
Frequently Asked Questions
What causes a persistently blocked nose?
Common causes include deviated nasal septum, inferior turbinate hypertrophy, nasal polyps, chronic sinusitis, nasal valve collapse, allergic rhinitis, and adenoid hypertrophy in children.
When should I see a specialist about a blocked nose?
See a specialist if obstruction has persisted for more than three months, is affecting sleep or quality of life, has not responded to nasal steroids, or is associated with loss of smell, facial pain, or recurrent sinus infections.
Can a blocked nose be fixed without surgery?
In many cases, yes. Nasal steroid sprays are effective for rhinitis-driven turbinate swelling and smaller polyps. However, structural causes such as significant septal deviation or bony turbinate hypertrophy typically require surgery for durable relief.
What is nasal valve collapse and can it be treated?
Nasal valve collapse occurs when the soft tissue of the nasal sidewall collapses inward on inspiration, narrowing the airway. It can be corrected surgically with spreader grafts or other structural rhinoplasty techniques.
Where does Mr Tim Biggs treat a blocked nose?
Mr Biggs assesses and treats nasal obstruction privately at Medicana Hospital in Winchester and Adnova Clinic in Fareham, Hampshire.
