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A nose that never fully clears is draining. Sleep becomes light, exercise feels harder, voices lose crispness and meals are less vivid without smell. When blockage and related symptoms are present on most days for twelve weeks or more, the pattern is considered chronic. The word blocked hides several different conditions. Three account for most long-running cases: rhinitis, chronic rhinosinusitis and nasal polyps. They overlap in symptoms yet behave differently and respond to different treatments. This guide explains what each means in plain English, the clues that separate them, safe first steps and when an ENT review helps.
What counts as chronic blockage
Colds and short seasonal flares come and go. Chronic means nasal obstruction, discharge, facial pressure or pain, and reduced sense of smell persist on most days for at least twelve weeks. Rhythm and context matter. A runny, itchy, sneezy nose that flares with pollen, dust or pets points towards rhinitis. Deep facial pressure that started after a respiratory virus and lingers points towards sinus lining inflammation. A gradually worsening blockage with marked smell loss that does not respond to decongestants suggests polyps. Noting persistence, triggers and whether symptoms are one-sided or fairly symmetrical helps steer the plan early.
Rhinitis: allergic and non-allergic
Rhinitis is inflammation of the nasal lining. In allergic rhinitis the immune system reacts to airborne triggers such as house dust mites, pet dander, pollens or moulds. Typical clues are bursts of sneezing, itch in the nose or eyes, clear watery discharge and congestion that correlates with exposure. Many people notice seasonal peaks outdoors. Dust-mite allergy often drives year-round symptoms indoors, especially in bedrooms. Non-allergic rhinitis feels similar but is not driven by allergy. Triggers include temperature changes, perfumes and cleaning products, tobacco smoke, reflux, some medicines and hormonal shifts. In both types the core problem is an over-reactive lining rather than infection, which is why antibiotics do not help. First-line treatment is regular intranasal corticosteroid spray used with correct technique over weeks, not days. Saline rinses improve comfort and clearance. If allergy is confirmed or strongly suspected, allergen reduction at home reduces the background load, and oral or intranasal antihistamines can help itch and sneeze. If symptoms remain troublesome despite good technique and adherence, an ENT or allergy review can confirm the pattern, optimise therapy and discuss immunotherapy in selected allergic cases.
Chronic rhinosinusitis: when the sinuses join the story
The sinuses are small air-filled spaces that ventilate and drain through narrow openings into the nose. Viruses, allergic flares and pollutants can swell the lining and narrow these channels. If swelling persists, mucus clearance slows, pressure builds and germs can overgrow. Chronic rhinosinusitis is defined by symptoms lasting at least twelve weeks together with evidence of ongoing inflammation on examination or imaging. Common features are nasal obstruction, thick discoloured discharge, facial pressure or pain that worsens on bending forwards and a reduced sense of smell. Unlike a simple short-lived sinus infection, chronic disease waxes and wanes across months. Management aims to restore ventilation and improve topical delivery. Daily saline irrigation reduces crusting and helps steroid sprays reach the target. Regular intranasal corticosteroids remain the backbone of treatment. Short courses of oral steroids may be considered for severe smell loss or heavy inflammation in carefully selected people. Antibiotics are not routine in chronic rhinosinusitis and are reserved for acute bacterial exacerbations with clear features such as fever and frank purulence. When symptoms persist despite good self-care, an ENT assessment helps. Nasal endoscopy can identify inflamed contact points, narrowed drainage pathways, hidden discharge and early polyp growth. A CT scan is sometimes used to map anatomy when surgery is being considered. Functional endoscopic sinus surgery opens natural drainage pathways and improves access for topical therapy. Even then, daily saline and intranasal steroids remain important to maintain control.
Nasal polyps: soft swellings that block and blunt smell
Nasal polyps are soft non-cancerous swellings that form in chronically inflamed nasal and sinus lining. They often present with steadily worsening blockage, a markedly reduced or absent sense of smell and a watery discharge rather than thick pus. Snoring may increase and many people describe a closed-up feeling that does not shift with decongestants. Polyps are commonly part of the chronic rhinosinusitis spectrum and can coexist with asthma and sensitivity to aspirin or similar drugs in some adults. First-line care is medical. Daily intranasal steroid sprays or steroid drops with correct technique are supported by regular saline irrigation. A short course of oral steroids may be used for severe smell loss or very bulky polyps, balancing benefits and risks. If symptoms persist or polyps are large, endoscopic sinus surgery can remove polyp tissue and open drainage, allowing topical therapy to work better long term. Relapse can occur, so maintenance with intranasal steroids and saline remains essential. Red flags that need prompt review include one-sided blockage, one-sided bleeding or discharge, crusting with pain, a visible mass on one side only or facial swelling. These patterns are not typical of simple polyps and should be assessed without delay.
Practical clues that separate the patterns
A few pointers help in everyday life. Itch and repeated sneezing point towards allergy, with flares around grass or olive pollen outdoors and dust-mite exposure in bedrooms. Clear watery discharge fits rhinitis. Thick discoloured discharge with facial pressure fits sinus lining inflammation, particularly if worse on bending. Pronounced smell loss with persistent bunged-up obstruction suggests polyps, especially if sprays and decongestants do little. Timing is useful. Rhinitis tends to fluctuate with exposure. Chronic rhinosinusitis and polyps produce a steadier background blockage across months. Laterality matters. Most benign inflammatory patterns are fairly symmetrical. One-sided symptoms or one-sided crusting deserve a check. Co-factors often add to the load. Reflux, smoking, occupational dusts, poorly controlled allergic disease, immune problems and anatomical narrowing such as a deviated septum can all complicate the picture and should be addressed. Finally, technique counts. Many people under-dose or misdirect sprays. A chin-down, head-neutral position with the nozzle aimed slightly outwards away from the septum and a gentle sniff after pressing improves comfort and effect and reduces throat drip.
Safe first steps you can try now
Two foundations make a large difference for most people. Use isotonic saline irrigation once or twice daily to wash away mucus and crusts and to help any medicated spray reach the lining. Use an intranasal corticosteroid spray every day for several weeks with correct technique. These measures are low risk and often improve sleep and daytime comfort. If the pattern is clearly allergic, an oral antihistamine can help itchy sneezy flares, and an intranasal antihistamine can be added when congestion is prominent. Avoid routine use of decongestant nasal sprays beyond a few days since overuse can cause rebound blockage. Tackle background drivers where relevant. Keep indoor air smoke-free, reduce dust-mite load in bedrooms, manage reflux carefully and maintain hydration and regular activity to support mucociliary clearance. If you use rinses, keep bottles and devices clean and follow the manufacturer’s hygiene instructions. Small steady habits usually beat sporadic bursts of treatment.
When an ENT review is the right next step
Book an assessment if congestion is present on most days for more than twelve weeks despite proper self-care, if your sense of smell is markedly reduced, if symptoms are mainly one-sided or if blockage comes with repeated nosebleeds. Seek help sooner if there is persistent fever, severe facial pain, swelling around an eye, double vision, a severe headache that is out of character or you feel generally unwell. An ENT appointment is calm and straightforward. The clinician will take a careful history, check your spray and irrigation technique and examine the nose and sinuses. Nasal endoscopy is a quick look with a thin camera to identify inflammation, secretions, narrowing and polyps. Treatment can then be matched to the pattern. That may include optimised topical therapy, short-term oral medicines where appropriate and surgery only when needed. The aim is practical relief that you can maintain.
Breathing more easily, day and night
Chronic nasal block is common and manageable. The key is to recognise the pattern you have, start with safe basics that calm the lining and improve clearance and get a clear diagnosis if symptoms persist or the story is one-sided or severe. With a tailored plan and a steady routine most people regain better airflow and a stronger sense of smell and everyday life feels less fogged and more comfortable.
