What is the treatment for a persistently blocked left nostril for 2 weeks?

Treatment for Persistent Left Nostril Blockage

Isotonic saline nasal irrigation is the first-line treatment for a blocked nostril persisting for 2 weeks, followed by intranasal corticosteroids if symptoms persist, with the addition of a short-term nasal decongestant for immediate relief.

First-Line Treatment Approach

Nasal Irrigation

• Begin with isotonic saline nasal irrigation 2-3 times daily 1
  • Isotonic saline is more effective than hypertonic or hypotonic solutions for nasal congestion 1
  • Can be delivered via nasal spray, squeeze bottle, or nasal pot depending on patient preference
  • Helps clear mucus, allergens, and inflammatory mediators

Intranasal Corticosteroids

• If symptoms persist after 3-5 days of saline irrigation alone, add an intranasal corticosteroid spray
• Apply twice daily for optimal effect 2
• Reduces mucosal inflammation and swelling
• Continue for at least 2-4 weeks for full benefit

For Immediate Symptom Relief

Nasal Decongestants

• Oxymetazoline nasal spray can provide rapid relief of nasal obstruction 3
• Important limitations:
  • Use for no more than 3-5 days to avoid rebound congestion
  • If needed for longer periods, combine with intranasal corticosteroids 2, 4
  • The combination of oxymetazoline plus intranasal corticosteroids is more effective than intranasal corticosteroids alone 2

Treatment Algorithm Based on Duration and Severity

1. Days 1-5: Isotonic saline nasal irrigation 2-3 times daily
2. Days 3-14: Add intranasal corticosteroid twice daily if no improvement
3. For severe congestion: Add oxymetazoline nasal spray (maximum 3-5 days) while continuing other treatments
4. If no improvement after 2 weeks of combined therapy: Consider systemic corticosteroids (prednisolone 25-60mg for 7-10 days) 2

Special Considerations

Preventing Rebound Congestion

• When using oxymetazoline, always combine with intranasal corticosteroids 4
• Studies show that concomitant use of intranasal corticosteroids can reduce rebound congestion when stopping oxymetazoline 4
• Continue the intranasal corticosteroid for at least 1 week after stopping the decongestant

When to Seek Further Evaluation

• If symptoms persist despite 2 weeks of appropriate therapy
• If symptoms are unilateral and persistent (as in this case)
• If accompanied by facial pain, purulent discharge, or fever
• Consider nasal endoscopy to evaluate for structural abnormalities, polyps, or other pathology 1, 2

Common Pitfalls to Avoid

• Using hypertonic saline which may cause more irritation than isotonic solutions 1
• Using decongestant sprays for more than 5 days without intranasal corticosteroids
• Discontinuing treatment too early (intranasal corticosteroids require consistent use for optimal effect)
• Failing to consider underlying causes of unilateral obstruction (foreign body, structural abnormality, tumor)

Remember that persistent unilateral nasal obstruction warrants careful evaluation to rule out anatomical causes or pathology if it doesn't respond to initial medical management.