When is a blocked nose more than a simple cold?

A blocked nose that will not clear can have many different causes — and they do not all need the same treatment:

Rhinitis: allergic rhinitis (triggered by pollen, house dust and similar), non-allergic (vasomotor) rhinitis, or rhinitis medicamentosa caused by long-term or incorrect use of nasal sprays
Adenoid hypertrophy: obstruction due to enlarged adenoids, common in children
Structural problems: problems arising from the anatomy of the nose itself, such as a deviated septum, enlarged turbinates or collapse of the nasal sidewall (valve narrowing)
Chronic sinusitis: symptoms lasting more than 12 weeks (3 months), accompanied by postnasal drip, loss of smell or facial pressure

Telling which of these applies to you is possible with a good history (when it started, whether it is seasonal, what makes it worse) and endoscopic examination — two patients who both come in saying “my nose is blocked” can have completely different causes and treatments.

What does one-sided blockage suggest?

When the blockage is on one side only, the first and most common cause that comes to mind is a deviated septum — the wall inside the nose bending to one side. This is often accompanied by compensatory enlargement of the turbinate on the opposite side.

In children, one-sided blockage — especially with a foul-smelling discharge — suggests a foreign body in the nose. In adults, a one-sided polyp or mass can also cause this picture. Although that is rare, I recommend that a one-sided, persistent blockage is not interpreted on your own but always assessed by endoscopic examination.

What is examined with the endoscope?

In the clinic I examine your nose with a thin endoscope — this lets me see directly the state of the septum, the size of the turbinates, whether there are polyps and the general appearance of the nasal lining. Anaesthesia is generally not needed; a medication applied inside the nose relaxes the area and makes the examination more comfortable. It takes a few minutes, and in most cases this examination clarifies the real cause of the blockage.

Medication, radiofrequency or surgery: how is the decision made?

The choice between the three depends on the real cause of the blockage. If the cause is an inflammatory condition such as allergic rhinitis, medical treatment (nasal spray, allergy treatment) is tried first. If the problem is enlarged turbinates and medication is not enough, radiofrequency turbinate reduction is usually the first choice — a method that can be done in the office and needs no operation.

But if the cause is structural, such as a deviated septum, or the turbinate enlargement is very advanced, radiofrequency is not enough and a surgical procedure such as septoplasty is needed. In short: we first clarify the cause, then together choose the least invasive option that will genuinely solve the problem.