Should I see a doctor: Sinus congestion

A stuffy nose or pressure in your face is often the first sign of a cold, but what about when those nosy annoyances aren’t going away?

We’ll break down sinus versus nasal conditions, how to treat both, and when to see a doctor or other health care provider.

What’s ‘normal’

First, understand the difference between the nasal passage and sinuses. The nasal passage starts at your nostrils, continues through to the nasopharynx and is the primary pathway for airflow. The sinuses are air-filled cavities in the facial bones that produce mucus, which drains into the nasal passage, where it’s naturally swallowed.

With a stuffy nose, it’s best to start by nailing down the cause. Nasal-based causes could include allergies, a deviated septum, nasal valve collapse or swollen turbinates (the bony structures inside the nose that filter, warm and humidify air). Sinus-based symptoms are likely a result of sinusitis, an inflammation or swelling of the tissue lining your sinuses, most often caused by a virus or bacteria.

If symptoms are resolved with over-the-counter medications, such as nasal spray, rinses or breathing strips, you’re safe to continue treating at home.

However, bacterial sinus infections will likely require antibiotics to fully treat. If your symptoms last longer than a week or feel more severe than the average flu/cold, visit your primary care provider or nearest urgent care clinic. Some more severe and untreated cases of sinusitis can lead to polyp formation that could block the sinuses and nasal passages.

What’s ‘not normal’

In most cases, sinus and nasal conditions are non-life-threatening, but can have severe impacts on your quality of life — especially in the long term. Living with ongoing congestion, pressure or limited airflow can affect your sleep, energy levels and ability to exercise.

Many people may simply “get used to it,” but you don’t have to.

If over-the-counter options, such as those in the next section, don’t provide relief after four to six weeks, it’s time to speak with your provider. They may choose to do a CT scan or refer you to an ear, nose and throat (ENT) specialist for a nasal endoscopy to determine if something more serious is going on.

While you may find relief with over-the-counter therapies, sometimes surgery is the better long-term solution. Surgery for nasal congestion can include septoplasty, turbinate reduction or nasal valve strengthening procedures.

Other reasons to consult your provider or a specialist about your symptoms include:

• Persistent stuffy nose with no other symptoms
• Loss of smell or a bad smell in your nose not present in the environment
• Severe sinus pressure/pain not resolved with over-the-counter pain relievers
• Red-flag symptoms: Unilateral eye swelling/redness or changes in vision, stiff neck, fever, headache, nausea/vomiting or confusion

How to care for your condition

Nasal sprays are a common over-the-counter medication, but it’s important to know the difference between your short- and long-term options.

Short-term nasal sprays like Afrin and phenylephrine work quickly to address symptoms, but should only be used three consecutive days at a time — any longer runs the risk of developing a dependency.

Long-term nasal sprays are typically steroids, such as Flonase, Nasacort or Nasonex, and work slower. They need to be used daily for up to six weeks to feel the full effect.

Other non-medicated options include Breathe Right strips or nasal rinses, like neti pots or NeilMed bottles, which are considered the best non-medicated option for treatment and prevention when used daily.

If you think allergies are the cause of your symptoms, try a daily over-the-counter antihistamine for a minimum of six weeks, or speak with your primary care provider about allergy testing options to determine if regular allergy shots may be a better fit.

Finding that the stuffy nose just isn’t going away with either of those? Try a six-week trial of a daily nasal rinse followed by a nasal steroid spray. If this clears up your nose, continue for the foreseeable future. If you find no relief, though, schedule a primary care appointment.

If you were prescribed an antibiotic for a sinus infection, be sure to complete the full round of prescribed antibiotics to avoid any lingering infection.

When in doubt about your symptoms — or maybe you’re finally fed up with that chronic stuffy nose — contact your primary care provider. They will determine if an ear, nose and throat specialist is needed.

Medical review provided for this piece by Michael Hubbell, MD, an otolaryngologist with the MultiCare Rockwood Clinic Ear, Nose and Throat Center.