Are you always congested? Experts weigh in on what to do and what to avoid.
By Hallie Levine
Maybe you’re still stuffy from a cold you had a month ago. Or your head and nose feel like they’re stuffed with cotton, even after fall allergies. You may not even be sure what is causing your sinus problems. In addition to respiratory infections and allergies, environmental irritants can trigger sinusitis. And sometimes the cause is a mystery.
But sinus problems, such as a runny or stuffy nose and sneezing, are certainly common. Other problems may include nasal pressure, decreased sense of smell, scabbing in the nose, and feeling like you have to clear your throat often.
And older adults are more susceptible to problems with these air-filled cavities behind the nose, cheekbones and forehead. “Your nose changes as you age,” says Dr. Kevin Hur, professor of otolaryngology at Keck Medicine of USC in Los Angeles. With age, the nose becomes less effective at expelling mucus, which becomes trapped in the sinuses and allows congestion and other unpleasant symptoms to persist.
Below are some common factors that are to blame for sinusitis and how to treat them.
Respiratory diseases and allergies
It is estimated that up to 30% of adults suffer from a stuffy or runny nose due to allergies to substances such as tree pollen, grass or weeds such as mold, pets, dust mites and cockroaches, it says. Allergist Dr. Zachary Rubin, spokesperson for the American College of Allergy, Asthma and Immunology. Additionally, older adults tend to have a less robust immune system, making them more prone to colds and flu, says Dr. Hiten Patel, a family medicine specialist at The Ohio State University Wexner Medical Center in Columbus. Both can cause sinus problems.
To do: Over-the-counter saline nose drops or saline rinses are the best option in both cases, Hur says. When you are congested, use them several times a day to help clear mucus. “It’s like showering: you can’t do it too many times,” she says. You can even do it preventatively, such as once or twice a day during cold and flu season. “It helps keep them (the sinuses) moist and healthy, and can help eliminate any viruses that can cause a cold.”
For a respiratory virus that is causing sinus problems, you can also use an over-the-counter steroid nasal spray such as fluticasone (Flonase) or triamcinolone (Nasacort) for a couple of weeks. This can help reduce nasal inflammation caused by the virus, Hur says. For allergies, an over-the-counter antihistamine nasal spray like azelastine (Astelin or Astepro) is a better option, Rubin says, and can quickly relieve congestion. If this doesn’t help, ask your doctor about prescription Dymista, which combines a nasal antihistamine with a steroid.
In both cases, an over-the-counter nasal decongestant spray, such as oxymetazoline (Afrin), may provide some relief. But using it for more than three days increases the risk of rebound congestion, Hur says. And be careful with oral decongestants, which may have ingredients like phenylephrine that can raise blood pressure, Patel says.
If the above strategies don’t help after about 10 days of a respiratory infection, or if you start to feel better and then get worse, consider having your doctor check for a bacterial sinus infection, especially if you also have pain and facial pressure, cough and low fever. You may need an antibiotic, Hur says. For persistent sinus allergy-related symptoms, ask about immunotherapy (given as injections or, for some allergens, sublingually).
When the cause is not so clear
Nonallergic rhinitis, caused by irritants such as tobacco or fireplace smoke, traffic smoke, strong odors, and changes in weather, can also cause sinus problems. “It is due to a dysregulation of the nerves in the nose that produce mucus,” Hur says.
Nasal congestion accompanied by dryness and crusting of the nose, or even nosebleeds, may indicate what is called atrophic rhinitis. “With age, nasal tissue thins and atrophies due to decreased blood flow to the nasal cavity,” says Dr. Peter Manes, an otolaryngologist at Yale University School of Medicine in New Haven, Connecticut. “The cartilage also weakens, which can change the shape of the nose.”
To do: If you suspect you may have nonallergic rhinitis, avoid potential triggers and use a saline nasal spray several times a day to clear mucus and irritants. Do you need more help? The prescription nasal spray ipratropium (Atrovent), which reduces the amount of mucus you produce, is helpful for a primarily runny nose, Manes says. For nasal congestion, antihistamine nasal sprays are usually quite effective. “It’s most likely because they have some kind of anti-inflammatory effect, and they can also calm the nerve endings in the nose,” says Manes. Treatment of atrophic rhinitis usually involves frequent spraying of the nose with a saline nasal spray.
Sinus problems that won’t go away?
If you don’t feel much better within a few weeks of trying some of the treatments above, it may be helpful to have an otolaryngologist examine your nose with an endoscope. “This allows us to detect mucus that could indicate an infection, as well as inflammation or even nasal polyps, benign growths in the lining of the nasal passages,” says Dr. Gregory Levitin, an otolaryngologist at the New York Eye and Ear Infirmary at Mount Sinai in New York. York. Sometimes the solution is simple. In the case of nasal polyps, for example, the injectable drug dupilumab (Dupixent) can help reduce their size.
But if the cause of persistent nasal symptoms is unclear, you may need a sinus CT scan. “Sometimes years of untreated inflammation have damaged sinus tissue,” says Levitin. “This can lead to chronic inflammation and swelling.” A small amount of such tissue can be removed in your doctor’s office, but more extensive sinus disease may require surgery performed under general anesthesia. This is considered relatively safe for older adults: In a study published in the American Journal of Rhinology & Allergy in 2022, the surgical complication rate was 3.9% for adults 70 years and older, but was higher (8%) for younger patients.
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Editor’s note: This article was also published in the October 2023 issue of Consumer Reports On Health.
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