Blocked Nose

Single-sided nasal blockage most commonly points to a structural cause — particularly a deviated nasal septum, where the central wall of the nose sits off-centre and narrows one passage. Turbinate enlargement on the wider side can compound this, as the turbinate expands to fill the additional space. A nasal polyp on one side, a septal spur, or rarely a nasal tumour can also cause unilateral obstruction. Unilateral blockage that is persistent and does not fluctuate with season or position warrants specialist assessment, particularly to exclude an underlying mass.

This is almost always the normal nasal cycle — a predictable physiological process in which the turbinates on each side of the nose alternately swell and shrink every two to six hours. The total nasal airflow remains roughly constant but the dominant side shifts. Most people never notice this unless their nasal passages are already narrowed by a deviated septum or turbinate hypertrophy, at which point the congested side feels completely blocked. It is not a sign of disease.

The nasal septum is the cartilage and bone that divides the nose into left and right passages. A perfectly straight septum is actually uncommon — most people have some degree of deviation. The deviation only becomes clinically significant when it narrows one nasal passage enough to cause persistent obstruction, affect sleep, limit exercise tolerance, or contribute to recurrent sinus infections. Minor deviations that cause no symptoms require no treatment.

The turbinates are three bony shelf-like structures on each side of the nasal cavity. They filter, warm, and humidify incoming air — an essential function. The inferior turbinates, the largest pair, are the most common cause of nasal obstruction when enlarged. They swell in response to allergens such as dust mite, pollen, and pet dander, to irritants like cigarette smoke, to viral infections, or as a compensatory response when the septum deviates to the opposite side. In some patients the swelling becomes chronic and no longer responds fully to medical treatment.

The nasal valve is the narrowest section of the nasal airway, located just inside the nostril. It can collapse or narrow due to weak cartilage, previous nasal surgery, trauma, or the natural changes of ageing. Patients often describe a feeling of the nostril pinching closed when breathing in. Unlike a deviated septum, nasal valve collapse is frequently missed on standard nasal examination and requires specific assessment. It can coexist with a deviated septum and may need to be addressed at the same time for surgery to be effective.

Allergic rhinitis — commonly called hayfever — occurs when the immune system overreacts to a specific allergen such as pollen, dust mite, or pet dander. Symptoms are typically triggered by exposure to the relevant allergen and often include sneezing and itchy, watery eyes alongside congestion. Non-allergic rhinitis produces identical nasal symptoms — congestion, runny nose, post-nasal drip — but allergy testing is negative and there is no identifiable allergen trigger. Common triggers for non-allergic rhinitis include temperature changes, strong smells, humidity, smoke, alcohol, and certain medications.

Yes — this is one of the most important things to understand about nasal decongestants. Sprays containing oxymetazoline — sold in Australia as Dimetapp, Sudafed nasal spray, Otrivin, and similar products — work rapidly by constricting nasal blood vessels. However, using them for more than three to five days causes a rebound effect: the blood vessels dilate even more when the spray wears off, producing worse congestion than before. This leads to dependence and a cycle of escalating use. The condition is called rhinitis medicamentosa. Breaking the cycle requires stopping the spray and replacing it with a saline rinse and an intranasal corticosteroid spray prescribed or recommended by a clinician.

The first-line treatment depends on the cause. For inflammatory causes — allergic rhinitis, non-allergic rhinitis, or chronic rhinosinusitis — daily intranasal corticosteroid sprays are the evidence-based first choice. Australian options include mometasone furoate (Nasonex), budesonide (Rhinocort), and fluticasone furoate (Avamys). These reduce mucosal inflammation and turbinate swelling with consistent daily use — maximum benefit develops over one to two weeks. Saline nasal irrigation used before the spray improves penetration and is recommended alongside it. For structural causes such as a deviated septum, medical treatment reduces any overlying inflammation but cannot correct the underlying anatomy.

Surgery is considered when symptoms are significant and persistent despite an adequate trial of medical treatment, or when the cause is structural and therefore not amenable to medication. The most common operation is septoplasty — correction of a deviated septum — usually combined with turbinoplasty to reduce enlarged inferior turbinates. This combined procedure is performed under general anaesthetic as day surgery, takes approximately 60 minutes, and leaves no external scars or bruising. In Australia, septoplasty attracts a Medicare rebate and private health insurance cover when documented nasal airflow obstruction is present. Your surgeon will advise on candidacy at your consultation.

Significantly. Nasal obstruction is a major driver of mouth breathing during sleep, which contributes to snoring, disrupted sleep architecture, and in some patients obstructive sleep apnoea. Mouth breathing during sleep also dries the throat, causes morning sore throat, and impairs the filtering and humidifying function that nasal breathing provides. Children with persistent nasal obstruction from enlarged adenoids are particularly susceptible to sleep-disordered breathing. Improving nasal airflow — whether through medical or surgical treatment — often produces meaningful improvements in sleep quality.

Yes. In children the most common cause of persistent nasal obstruction is enlarged adenoids — lymphoid tissue at the back of the nasal cavity that is proportionally much larger in children and can block the airway completely. This is uncommon in adults. Other causes in children include allergic rhinitis, a foreign body in the nose (particularly relevant when one nostril is blocked and there is an unusual smell or discharge), and in young children or infants, congenital narrowing. A nasal polyp in a child should always prompt investigation for cystic fibrosis.

Individual surgeons within My-ENT may approach assessment and management differently based on their subspecialty training and clinical experience. Your surgeon will discuss the most appropriate pathway for your specific situation at your consultation.