What are the treatment options for a blocked nostril?

Treatment of Blocked Nostril

Intranasal corticosteroids are the first-line treatment for nasal obstruction, with mometasone furoate, fluticasone propionate, or fluticasone furoate preferred due to their negligible bioavailability, once-daily dosing, and superior safety profile. 1

First-Line Medical Management

Intranasal Corticosteroids (Primary Treatment)

• Intranasal corticosteroids are the mainstay therapy for patients with nasal congestion symptoms and require long-term adherence for optimal benefit. 1
• Mometasone furoate, fluticasone propionate, and fluticasone furoate are generally preferred because they have negligible bioavailability, less potential for systemic side effects, and only require once-daily usage. 1
• These medications are effective for both allergic rhinitis and chronic rhinosinusitis-related nasal obstruction. 1
• Patients with persistent moderate to severe allergic rhinitis should be treated initially with an intranasal corticosteroid either alone or in combination with an intranasal antihistamine. 2

Saline Irrigation (Adjunctive Therapy)

• Regular saline nasal irrigation 2-3 times daily helps clear mucus, reduce inflammation, and improve the efficacy of intranasal corticosteroids by clearing the nasal passages. 3
• This mechanical treatment can remove allergens and reduce mucosal inflammation. 4

Second-Line and Combination Therapies

Intranasal Antihistamines

• For patients with inadequate response to intranasal corticosteroids alone, adding an intranasal antihistamine (azelastine or olopatadine) provides the most effective combination therapy. 1, 2
• Intranasal antihistamines can also be used as monotherapy for mild intermittent allergic rhinitis. 2

Oral Antihistamines

• Second-generation H1 antihistamines (cetirizine, fexofenadine, desloratadine, loratadine) are appropriate for mild intermittent or mild persistent allergic rhinitis. 2
• However, combining oral antihistamines with intranasal corticosteroids does not offer significant additional benefit for nasal obstruction compared to intranasal corticosteroids alone. 1

Short-Term Decongestants (Use with Caution)

• Intranasal decongestants should only be used for very short courses (not longer than 5 days, preferably shorter) in adults with severe nasal obstruction while coadministering other drugs. 1
• Nasal decongestants reduce symptoms of nasal blockage but are symptomatic only, do not influence disease course, and risk causing rhinitis medicamentosa (rebound congestion) with prolonged use. 1
• Intranasal decongestants should NOT be used in preschool children. 1
• Oral decongestants should not be used regularly due to adverse effects outweighing minimal symptom reduction benefits. 1

Oral Corticosteroids (Severe Cases)

• Consider a short course of oral corticosteroids (prednisone for 5-7 days) if symptoms are severe and not responding to intranasal treatment within 1 week, particularly when there is marked turbinate swelling. 3

Alternative and Supplemental Therapies

Herbal Medicines

• BNO1016 (Sinupret), Cineole, Andrographis paniculata SHA-10 extract, Myrtol, and pelargonium extracts have demonstrated significant impact on symptoms without important adverse events for common cold and post-viral acute rhinosinusitis. 1

Zinc

• Zinc acetate or zinc gluconate lozenges at doses ≥75 mg/day, taken within 24 hours of symptom onset, significantly reduce the duration of common cold when used throughout the illness. 1

Vitamin C

• Given the consistent effect on duration and severity of colds in regular supplementation studies, low cost, and safety, therapeutic vitamin C may be worthwhile for individual patients to trial. 1

When to Consider Surgical Intervention

• Septoplasty or turbinate reduction should only be considered after documented failure of at least 4 weeks of appropriate medical therapy, including intranasal corticosteroids, saline irrigations, and mechanical treatments. 5, 4
• Surgery is indicated when there is septal deviation or turbinate hypertrophy causing continuous nasal airway obstruction with symptoms affecting quality of life despite medical management. 5
• Combined septoplasty with turbinate reduction provides better long-term outcomes than septoplasty alone when both conditions are present. 5

Common Pitfalls to Avoid

• Avoid prolonged use of intranasal decongestants beyond 3-5 days, as this leads to rhinitis medicamentosa (rebound congestion). 1
• Do not proceed with surgery without documenting at least 4 weeks of failed medical management with intranasal corticosteroids. 5, 4
• Intermittent Afrin use does not constitute appropriate medical therapy and represents rhinitis medicamentosa, not failed medical management. 4
• Do not assume all septal deviations require surgical correction—only 26% of septal deviations are clinically significant. 5