Chronic nasal congestion can result from a variety of underlying causes, including both inflammatory and structural factors. The nasal septum, which separates the two nasal passages, may be deviated due to developmental issues, past injuries, or previous surgeries, leading to persistent obstruction. Additionally, enlargement of the turbinates, narrowing of the nasal valves, or weakness in the outer nasal walls can further restrict airflow. Many individuals experience a combination of these structural abnormalities alongside inflammation, complicating treatment efforts.

One common inflammatory cause is chronic rhinosinusitis, characterized by nasal congestion lasting more than 12 weeks, often accompanied by nasal discharge, facial pressure, and reduced sense of smell. In some cases, patients develop nasal polyps—non-cancerous growths that can block nasal passages and impair olfaction. While tumors in the nose and sinuses are rare, persistent congestion affecting only one side of the nose warrants prompt medical evaluation. Likewise, sudden unexplained loss of smell or worsening symptoms should be assessed by a healthcare professional.

Diagnosis typically involves examination by an ear, nose, and throat (ENT) specialist, who may use a nasal endoscope for detailed inspection. Additional investigations such as allergy testing or computed tomography (CT) scans can aid in determining the underlying cause.

Initial management often involves saline sprays or rinses, which are safe and effective for clearing mucus and irritants. For inflammation-related congestion, corticosteroid nasal sprays are generally preferred over decongestants and require consistent daily use over several weeks. In cases where allergies play a significant role, antihistamine tablets or nasal sprays may be added to the treatment regimen. Decongestant sprays like xylometazoline or oxymetazoline offer rapid relief but are recommended for use no longer than five days due to the risk of rebound congestion, where symptoms worsen with prolonged use.

Antibiotics are seldom indicated unless there is a clear bacterial infection. When structural issues persist despite medical therapy, surgical intervention may be necessary. Surgery is tailored to the specific cause, such as correcting a deviated septum or addressing turbinate enlargement, since sprays cannot alter the physical shape of the nose.

In rare cases, patients may experience a sensation of nasal blockage despite an open nasal airway due to impaired sensation in the nasal mucosa. This occurs because airflow detection relies on cold receptors in the nasal lining, which can be damaged.

Patients experiencing unilateral blockage, nasal bleeding, pain, foul-smelling discharge, or loss of smell should seek prompt medical attention. Those with persistent symptoms unresponsive to self-care should consult a general practitioner for potential referral to an ENT specialist.