Blocked Nose That Won’t Clear: Polyps, Deviated Septum or Something Else?

Most people know what a blocked nose feels like. A cold comes along, breathing gets difficult for a few days, and then it clears. Annoying, but temporary. The kind of thing you push through with some steam inhalation and a decongestant spray.

But then there are people who’ve been dealing with a blocked nose for months. Maybe longer. They’ve tried every spray on the pharmacy shelf. The steam helps briefly and then it’s back. One side is always more blocked than the other. Or both sides feel congested constantly, regardless of the season or whether they’re sick.

At some point, that stops being “just a stuffy nose” and becomes something worth investigating properly. Because a blocked nose that doesn’t clear on its own usually has a reason and knowing what that reason is changes how it gets treated.

Why the Nose Gets Blocked

The nasal passage is more complex than it appears from the outside. Inside, there are structures called turbinates bony shelves lined with tissue that warm, humidify, and filter the air before it reaches the lungs. The nasal septum divides the two sides. And the whole space is lined with a mucous membrane that can swell in response to infection, irritation, or allergy.

Blockage happens when any of these structures enlarge, shift out of place, or develop growths that reduce the available airspace. Understanding which one is causing the problem is what determines the right treatment.

Common Causes of a Persistently Blocked Nose

Deviated Nasal Septum

The nasal septum is the thin wall of cartilage and bone that runs down the middle of the nose, separating the two nostrils. Ideally it sits perfectly in the centre but in reality, a significant number of people have a septum that’s off to one side to some degree.

This is called a deviated septum. It can happen from birth, or develop after a knock or injury to the nose sometimes years before the blockage becomes noticeable. A mildly deviated septum often causes no symptoms. A significantly deviated one narrows one nasal passage considerably, making breathing through that side difficult or impossible.

The most telling sign is blockage that’s consistently worse on one side. The other side may feel relatively fine, while one nostril always feels partially or fully closed. Decongestants might provide temporary relief, but they don’t correct the structural problem underneath.

Nasal Polyps

Nasal polyps are soft, non-cancerous growths that develop from the lining of the nasal passages or sinuses. They form as a result of chronic inflammation often from longstanding allergies, asthma, or recurrent sinus infections.

Small polyps may not cause any symptoms at all. Larger ones, or multiple polyps, start blocking airflow. The blockage tends to affect both sides and comes with a fairly distinct set of accompanying symptoms:

• A reduced or absent sense of smell – this is one of the more noticeable effects and something people often describe as one of the most disruptive
• A runny nose that’s persistent, often with a watery or mucus discharge
• Postnasal drip – the sensation of mucus draining down the back of the throat
• A feeling of pressure or fullness in the face
• Snoring or disrupted sleep from breathing difficulty

Polyps don’t cause pain on their own. The discomfort, when present, usually comes from associated sinus pressure rather than the polyps themselves.

Chronic Sinusitis

Chronic sinusitis inflammation of the sinuses lasting twelve weeks or longer, is closely linked to nasal polyps and is often present alongside them. The sinuses can’t drain properly when the nasal passages are blocked, and that trapped mucus creates an environment where bacteria or fungal infections can take hold.

Persistent nasal blockage, facial pressure, discoloured nasal discharge, and a reduced sense of smell are the hallmarks. Chronic sinusitis can exist without polyps, but the two frequently occur together.

Turbinate Hypertrophy

The turbinates those bony structures inside the nose, can enlarge in response to chronic allergies, irritants, or infection. This is called turbinate hypertrophy, and it’s a very common but often overlooked cause of nasal blockage.

When the turbinates are consistently swollen, the nasal passage narrows. Decongestant sprays work by temporarily shrinking the turbinates, which is why they provide short-term relief, but using them too frequently can actually cause the turbinates to enlarge further when the medication wears off. This is called rebound congestion, or rhinitis medicamentosa, and it’s a cycle that makes the original problem worse over time.

Allergic Rhinitis

Allergic rhinitis commonly called hay fever, though it isn’t always seasonal, occurs when the nasal lining overreacts to airborne allergens like dust mites, pollen, pet dander, or mould. The lining swells, mucus production increases, and the result is a blocked, runny nose alongside sneezing and itchy eyes.

When allergic rhinitis is chronic, meaning it happens year-round rather than just in certain seasons, it can feel like a permanently blocked nose that never fully clears. Managing the allergy is central to managing the blockage.

Non-Allergic Rhinitis

Not all chronic nasal congestion is allergy-related. Non-allergic rhinitis produces similar symptoms congestion, runny nose, postnasal drip, but allergy tests come back normal. Triggers include temperature changes, humidity, strong smells, certain foods, hormonal changes, and medications.

It’s less well understood than allergic rhinitis and can be harder to treat, but identifying that it isn’t allergy-driven changes the management approach.

Less Common Causes Worth Knowing

A few other possibilities that come up in clinical evaluation:

• Adenoid enlargement – more common in children but can affect adults too; the adenoids sit at the back of the nasal passage and when enlarged, they block airflow significantly
• Foreign body – particularly in young children, a small object lodged in the nose can cause persistent one-sided blockage with discharge
• Nasal tumours – rare, but persistent one-sided blockage, nosebleeds, and facial pain together warrant investigation to rule this out
• Septal perforation – a hole in the nasal septum, sometimes from previous surgery, injury, or certain medications, that disrupts normal airflow

How Is a Persistently Blocked Nose Investigated?

A proper evaluation starts with a clinical history and physical examination. An ENT specialist will ask about how long the blockage has been present, whether it affects one or both sides, what makes it better or worse, and what other symptoms are present.

A nasoendoscopy – where a thin, flexible scope is passed gently into the nose, gives a direct view of the nasal passages, turbinates, septum, and the opening to the sinuses. It’s a quick, in-clinic procedure that provides far more information than looking at the outside of the nose alone.

A CT scan of the sinuses is often recommended when chronic sinusitis or polyps are suspected, as it shows the extent of the problem and helps guide treatment planning.

Allergy testing may be arranged if an allergic component is suspected but hasn’t been confirmed.

Treatment From Medication to Surgery

Treatment depends entirely on the cause.

For allergic rhinitis – antihistamines, nasal corticosteroid sprays, and allergy management form the core. Identifying and reducing exposure to specific triggers is important alongside medication.

For nasal polyps – nasal corticosteroid sprays are the first-line treatment and can shrink smaller polyps significantly over time. Oral steroids are used for more significant cases. When polyps are large, numerous, or not responding to medication, surgery becomes necessary.

For chronic sinusitis – treatment begins with medication: antibiotics for bacterial infection, steroid sprays, saline rinses. When medical management isn’t achieving adequate results, functional endoscopic sinus surgery (FESS) – a minimally invasive procedure done through the nostrils, is used to open up blocked sinus passages and remove polyps. No external incisions are involved.

For a deviated septum – if the deviation is significant enough to cause persistent symptoms and isn’t improving with other measures, a septoplasty is the surgical correction. It straightens the septum from the inside, improving airflow through the affected side. It’s done under general anaesthesia, recovery takes about a week or two, and the results are generally very good.

For turbinate hypertrophy – if conservative measures haven’t helped, a procedure to reduce the size of the turbinates can be done, often at the same time as a septoplasty when both problems are present.

When Should You See an ENT Specialist?

If the blockage has been present for more than a few weeks without a clear cause like an ongoing cold or known seasonal allergy, it’s worth getting it properly evaluated. Particularly if:

• One side is always more blocked than the other
• Sense of smell has reduced or disappeared
• Decongestant sprays have become a daily dependency
• There are recurring sinus infections
• Sleep is being disrupted by breathing difficulty
• Facial pressure or headaches are accompanying the blockage

A blocked nose sounds minor. But when it’s been there for months and is affecting sleep, smell, concentration, and daily comfort, that’s a quality of life issue, and it deserves a proper answer.

Final Thoughts

A persistently blocked nose isn’t something to just live with. Most causes, whether a deviated septum, polyps, chronic sinusitis, or turbinate hypertrophy, are diagnosable and treatable. The right treatment depends on what’s actually causing the problem, which is why proper evaluation matters more than trying one pharmacy remedy after another.

Our ENT specialist evaluates nasal and sinus conditions thoroughly, from identifying the underlying cause to recommending the most appropriate treatment, whether that’s medication, a minor procedure, or surgical correction. If you’ve been dealing with a blocked nose that just won’t clear, come in for an assessment. There’s usually a clear answer, and more often than not, a clear solution.