A blocked nose is one of those symptoms that feels almost too ordinary to worry about. Many people assume it is just allergies, a lingering cold, or something they have to live with. Nasal sprays are bought, tablets are tried, and life carries on. But when nasal blockage becomes constant, lasting for weeks or even months, it often signals that something more complex is going on inside the nose or sinuses.
Persistent nasal obstruction is more than just uncomfortable. It can affect sleep, exercise, concentration, sense of smell, and overall quality of life. For some people, it becomes so familiar, that they forget what clear breathing actually feels like. This is often the point at which specialist assessment becomes important.
This article explains the common causes of long-term nasal blockage, when medication may no longer be enough, what an ENT surgeon can assess for that others cannot, and why specialist nose and sinus expertise matters when symptoms do not settle.
Common causes of long-term nasal blockage
A nose that feels blocked all the time is rarely due to a single simple factor. In many cases, several anatomical and inflammatory issues combine. The most common causes seen in specialist ENT practice include structural problems, chronic inflammation, and soft tissue enlargement inside the nose.
A deviated septum is one of the most frequent structural causes. The septum is the wall of cartilage and bone that divides the nose into left and right sides. In many people, it is not straight. A significant deviation can narrow one side of the nasal airway and disrupt airflow, leading to a constant sensation of blockage. This can be present from birth or result from past injury, even one that happened many years ago.
Turbinate enlargement is another very common contributor. Turbinates are soft tissue structures inside the nose that help warm and humidify the air you breathe. When they become chronically enlarged, often due to allergies or long-term irritation, they can occupy too much space within the nasal cavity. Even if the septum is relatively straight, enlarged turbinates can create the feeling that the nose is always congested.
Chronic rhinosinusitis is a long-standing inflammatory condition of the lining of the nose and sinuses. Unlike acute sinus infections, it does not always cause pain or fever. Instead, it often presents as persistent blockage, stuffiness, pressure, reduced smell, and post-nasal drip. This inflammation can last for months and tends to fluctuate rather than fully resolve.
Nasal polyps are soft, non-cancerous growths that arise from chronically inflamed nasal lining. They can grow large enough to physically block airflow, particularly at the back of the nose. People with nasal polyps often describe breathing through their nose as feeling like breathing through cotton wool, and sprays may provide only limited or temporary relief.
These conditions are not always obvious from the outside. Many people with significant internal nasal obstruction have a normal-looking nose and no dramatic symptoms beyond the blockage itself.
“A blocked nose that won’t go away isn’t just frustrating — it’s often a sign of an underlying condition that needs specialist care. If symptoms persist despite medication, an ENT assessment can identify the cause and provide lasting relief.”
-Mr Vikas Acharya
Consultant ENT Surgeon, London
When medication isn’t enough
For early or mild nasal problems, medical treatment is often the first step. Saline rinses, steroid nasal sprays, antihistamines, and short courses of oral medication can be very effective. In fact, most if not all, nasal conditions should be treated medically before any surgical options are considered.
However, there are clear signs that medication may no longer be enough on its own. One of the most important is duration. If nasal blockage has persisted for several months despite correct use of sprays and tablets, it is unlikely to resolve fully without further investigation. Using sprays intermittently or incorrectly can limit their benefit, but even with proper use, some conditions simply do not respond adequately.
Another sign is dependence on decongestant sprays. Over-the-counter sprays that shrink the nasal lining can feel like a miracle at first. Unfortunately, using them for more than a few days can cause rebound congestion, making the blockage worse when the spray wears off. Many patients reach a cycle where they cannot breathe without the spray, yet feel permanently blocked and need more and more of the spray to get the same effect. It is a vicious cycle, and one that is hard to break.
A reduced or lost sense of smell is also a red flag. While allergies can affect smell temporarily, long-term loss often suggests chronic inflammation or nasal polyps. This symptom tends to be under-reported, yet it provides valuable information about what is happening inside the nose.
Sleep disturbance is another important factor. Chronic mouth breathing at night, snoring related to nasal obstruction, or waking with a dry mouth can all indicate that the nose is not functioning properly. Poor nasal airflow can significantly affect sleep quality, even in people who do not consider themselves poor sleepers.
When symptoms persist despite appropriate medical treatment, a more detailed assessment becomes necessary to understand why improvement has stalled.
What an ENT surgeon can assess that others can’t
One of the main differences between a general assessment and a specialist ENT evaluation is the ability to directly visualise the inside of the nose in detail. This is usually done by nasal endoscopy, a slim camera that allows a clear view of the nasal passages and sinus openings.
Through endoscopy, an ENT surgeon can identify septal deviation, turbinate enlargement, subtle inflammation, nasal polyps, and structural narrowings that cannot be seen during a routine examination. It also allows assessment of how different areas interact during breathing, which is important in understanding why symptoms feel worse on one side or fluctuate throughout the day.
Imaging, such as CT scanning of the sinuses, may also be used when indicated. This provides detailed information about sinus anatomy, drainage pathways, and areas of chronic inflammation. It is particularly useful in cases of suspected chronic rhinosinusitis or when surgery is being considered.
Equally important is interpretation. Many people may have minor anatomical variations that are visible on scans but are not responsible for their symptoms. A specialist’s role is to correlate findings with symptoms, not simply identify abnormalities. This helps avoid unnecessary treatment and ensures that any intervention is targeted and appropriate.
ENT surgeons also assess the response to previous treatments. Understanding what has helped, what has not, and how symptoms have evolved over time provides critical clues about the underlying cause and the best next step.
Why specialist nose and sinus expertise matters
Nasal surgery and sinus treatment are highly specialised areas within ENT. The nose is a delicate structure with complex airflow dynamics, and small changes can make a significant difference to breathing and symptoms.
Specialist expertise matters because treatment should be tailored to the specific problem. A deviated septum may benefit from septal surgery, while turbinate enlargement may be managed with targeted reduction techniques. Chronic rhinosinusitis may require a combination of medical optimisation and, in selected cases, endoscopic sinus surgery to restore normal drainage and airflow.
Equally, many patients do not need surgery at all. Specialist assessment often reassures patients that their symptoms can be managed conservatively, or that optimisation of medical therapy is likely to help when guided correctly.
Experience also plays a role in setting realistic expectations. Improvement in nasal breathing is often gradual rather than instant, particularly when inflammation has been present for a long time. Understanding what improvement looks like and how long it may take is an important part of successful treatment.
Most importantly, specialist care focuses on long-term outcomes. The goal is not simply short-term relief, but sustained improvement in nasal function, sleep quality, and day-to-day comfort.
Local specialist care in Hertfordshire
I see patients from Bushey, Watford, Radlett, St Albans and across Hertfordshire and North London who have lived with nasal obstruction for years. Many arrive having tried multiple sprays, tablets, and home remedies without lasting benefit. For some, the blockage has become normalised, even though it continues to affect their sleep, exercise, and concentration.
A careful specialist assessment often provides clarity. Understanding exactly why the nose feels blocked allows a clear plan to be made, whether that involves refining medical treatment or discussing procedural options in a measured and informed way.
When should you consider booking a consultation?
If your nose has been blocked most days for several months, if sprays only help briefly, or if your sense of smell has reduced, it is reasonable to seek specialist input. Nasal obstruction is not something you simply have to accept, and effective treatment depends on understanding the underlying cause rather than repeatedly masking the symptoms.
If you are struggling with a blocked nose and would like a specialist opinion, you can book a consultation in Bushey or Central London.
