Chronic Congestion

– Elisabeth Winterkorn, MD

The most common causes of chronic nasal congestion are viral illnesses and allergies. As we all know, viruses frequently cause fever, runny nose, headache, sore throat, and congestion. Generally the symptoms are worst during the first week or two, however, the cough associated with viruses can often last 14-20 days before the post-nasal drip and congestion finally subside.

Allergies can cause symptoms very similar to viral illnesses, though are not accompanied by fever. Frequently allergies cause sneezing, runny nose, headache, itchy eyes, increased eczema symptoms, and sore throat. We generally determine the cause of allergies based on the time of year: spring – grasses and pollen; summer – trees and mold; fall – ragweed; winter – dust and indoor allergens. We do not routinely recommend testing for a particular allergen unless the symptoms are persistent and difficult to treat, you have difficult to control asthma, or we are strongly considering referral to an allergist for immunotherapy (“allergy shots”).

Many patients and families worry about the development of sinusitis in the setting of prolonged nasal congestion and cough. While sinusitis is a possibility, there are specific signs that your provider will evaluate to determine whether a bacterial illness is present that needs to be treated with an antibiotic. Many times we can catch and treat chronic congestion before it turns into a bacterial illness – this is the goal, as it reduces antibiotic administration and all the negative side effects that go along with antibiotic use.


We generally use a combination of medications and other non-drug therapies to try to help reduce the congestion. Depending on the cause of the congestion, these treatments may be used for a period of weeks to months.

Nasal Saline Wash – as it sounds, this is a direct washing of the inside of the nose. It helps to wash away some of the thicker and stickier nasal mucous and allows the body to naturally clear out the remaining congestion within the sinuses. We commonly recommend using either a NetiPot or the Neil Med Sinus Rinse.

Antihistamines – these are medications that reduce the body’s natural response to allergens. They cause the body to produce less nasal mucous and reduce the swelling of the mucous-producing glands in the nose. Some examples of these medications are Benadryl (diphenhydramine), Zyrtec (cetirizine), Claritin (loratidine), and Allegra (fexofenadine). The most common side effects of these medications are to cause dry mouth, dry eyes, and fatigue.

Decongestants – these are medications that dry up nasal secretions. A common example of a nasal decongestant is Sudafed or Dimetapp (pseudephedrine). The most common side effects of these medications are jitteriness, dry mouth, and dry eyes.

Nasal steroids – these are low-dose steroid formulations that are sprayed directly onto the swollen nasal mucous membranes. They reduce the inflammation within the nose, reduce the mucous production by the nasal membranes and again, allow the body to clear the mucous more easily from the sinuses. Most frequently we will prescribe either Flonase (fluticasone) or Nasonex (mometasone). The most common side effects of these medications are dry nose and bloody nose. Because this is sprayed on the mucous membrane directly, we can give very low dose of steroid and there is minimal absorption into the body. These work best when given consistently for at least a few weeks.

Antibiotics – if your provider does conclude that your symptoms are consistent with a bacterial infection in the sinus/ear/lung, we will prescribe an appropriate antibiotic to be used alongside the other therapies listed above.

Environmental controls – if you have allergies, we recommend trying to reduce your exposure to whatever seems to make you allergic. This includes using dust mite covers on sheets and pillows, frequent washing of bedding, and the use of HEPA filters on vacuums and air purifiers.

We do not recommend using cough suppressants as they may actually increase the risk of developing bacterial sinus or lung infections.

Return to the office for reevaluation if you are not feeling better within 7-14 days, or if you develop a new fever, ear pain, chest pain, trouble breathing, headache, nosebleeds, or you have any further concerns.