What are the treatments for a clogged nostril?

Treatment of a Clogged Nostril

For a clogged nostril, start with intranasal corticosteroids (such as mometasone or fluticasone) as first-line therapy, combined with nasal saline irrigation, as these provide the most effective relief for nasal congestion regardless of the underlying cause. 1, 2

Initial Treatment Approach

First-Line Therapies

• Intranasal corticosteroids are the most effective monotherapy for both allergic and non-allergic causes of nasal congestion, with onset of action within 12 hours (though full benefit may take several days to weeks). 1, 3 These should be used at the lowest effective dose, with sprays directed away from the nasal septum to prevent mucosal erosions. 2, 3

• Nasal saline irrigation should be used concurrently, as it mechanically removes mucus, reduces inflammation, and enhances the effectiveness of other treatments when performed 10-20 minutes before using corticosteroid sprays. 1, 4, 5 This can be done with home-made isotonic saline (equally effective as commercial products) or ready-mixed solutions, applied 2-3 times daily. 4, 5

Short-Term Adjunctive Options

• Intranasal decongestants (oxymetazoline or phenylephrine) provide rapid relief within minutes and can be used for no more than 3-5 days to avoid rhinitis medicamentosa (rebound congestion). 1 Recent evidence suggests up to 7-10 days may be safe with proper dosing, but the traditional 3-day limit remains the safest recommendation in clinical practice. 6

• Oral decongestants (pseudoephedrine) can relieve nasal congestion but should be used cautiously in patients with hypertension, cardiac arrhythmias, insomnia, prostate hypertrophy, or glaucoma. 2, 7

Symptom-Specific Algorithm

If Congestion is the Primary Symptom:

1. Start intranasal corticosteroid (2 sprays per nostril daily) 2, 3
2. Add nasal saline irrigation (2-3 times daily) 1, 5
3. Consider short-term intranasal decongestant (≤3 days) for severe acute congestion 1, 2

If Rhinorrhea (Runny Nose) Accompanies Congestion:

1. Start intranasal corticosteroid 2, 3
2. Add intranasal anticholinergic (ipratropium bromide, 2 sprays per nostril 2-3 times daily) - particularly effective for rhinorrhea 1, 8, 2
3. Add nasal saline irrigation 1, 5

If Symptoms Suggest Allergic Rhinitis (Sneezing, Itching, Clear Discharge):

1. Intranasal corticosteroid (first-line) 1, 3
2. Consider adding intranasal antihistamine (azelastine, 2 sprays per nostril twice daily) - this combination is more effective than either alone 1, 2, 3
3. Oral second-generation antihistamines (cetirizine, loratadine, fexofenadine) can be added but are less effective for congestion specifically 3

If Symptoms Suggest Non-Allergic/Vasomotor Rhinitis (Triggered by Temperature Changes, Odors, No Allergic Features):

1. Intranasal corticosteroid 8, 2
2. Intranasal antihistamine (azelastine) - effective for vasomotor rhinitis 8, 2
3. For predominant rhinorrhea: intranasal anticholinergic 8, 2
4. Avoid oral antihistamines (not effective for non-allergic rhinitis) 2, 3

Critical Pitfalls to Avoid

• Never use intranasal decongestants for more than 3-5 days - this leads to rhinitis medicamentosa, worsening the original congestion. 1, 2 If this has already occurred, discontinue the decongestant and start intranasal corticosteroids immediately. 2

• Do not use first-generation antihistamines (diphenhydramine, chlorpheniramine) as they cause significant sedation, impair driving and work performance, and are less effective than newer options. 1, 3

• Avoid oral corticosteroids except in rare cases of severe intractable symptoms, as they have significant systemic side effects with minimal additional benefit over intranasal formulations. 3

• Direct intranasal sprays away from the nasal septum (aim toward the outer wall of the nose) to prevent septal perforation with long-term corticosteroid use. 2, 3

When Symptoms Persist

If congestion does not improve after 7-15 days of appropriate treatment:

• Consider acute bacterial rhinosinusitis if symptoms worsen after initial improvement, persist beyond 10 days, or include purulent discharge with facial pain/pressure. 1 In this case, add amoxicillin or amoxicillin-clavulanate for 5-10 days. 1

• Evaluate for anatomic obstruction (deviated septum, nasal polyps) or chronic rhinosinusitis requiring specialist referral. 2, 3

• Refer to an allergist/immunologist for prolonged symptoms unresponsive to standard therapy, complications, or consideration of immunotherapy. 3

Symptomatic Relief Measures

• Analgesics (acetaminophen or ibuprofen) can relieve associated facial pain or headache. 1

• Humidification helps prevent nasal dryness and crusting, particularly after bleeding or with chronic symptoms. 1

• Avoid irritant triggers (smoke, strong odors, temperature extremes) when possible, especially in vasomotor rhinitis. 8