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Nasal Congestion and Discharge

(Runny Nose; Rhinorrhea)

By

Marvin P. Fried

, MD, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine

Reviewed/Revised May 2023
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Topic Resources

Nasal congestion and discharge (a runny nose) are extremely common problems that commonly occur together but occasionally occur alone.

Causes of Nasal Congestion and Discharge

Common causes

Less common causes

Less common causes include

Fluid sometimes drains from an infected sinus.

The Nose
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Children sometimes put a foreign object in their nose. If adults do not see them do this, the first sign may be a foul-smelling nasal discharge due to infection and irritation from the foreign object. Rarely, adults with mental disorders put objects in their nose.

People who use nasal decongestant sprays for more than 3 to 5 days often experience significant rebound congestion (the return of congestion that is worse than before) when the effects of the decongestant wear off. People then continue using the decongestant in a vicious circle of persistent, worsening congestion. This situation (rhinitis medicamentosa) may persist for some time, and people may misinterpret it as a continuation of the original problem rather than a consequence of treatment.

People with vasomotor rhinitis have a recurrent watery nasal discharge that occurs without any known triggers.

Table

Evaluation of Nasal Congestion and Discharge

Not all episodes of nasal congestion and discharge require immediate evaluation by a doctor. The following information can help people decide whether a doctor’s evaluation is needed and help them know what to expect during the evaluation.

Warning signs

In people with nasal congestion and discharge, certain symptoms and characteristics are cause for concern. They include

  • Discharge from only one side of the nose, particularly if it contains pus or blood

  • Face pain, tenderness, or both

When to see a doctor

People should see a doctor right away if either of the following occurs:

People who have nasal congestion and discharge but no warning signs should call their doctor. They may not need to be seen, particularly if they have typical cold symptoms and are otherwise healthy.

What the doctor does

Doctors first ask questions about the person's symptoms and medical history and then do a physical examination. What doctors find during the history and physical examination often suggests a and the tests that may need to be done.

During the medical history, doctors ask about the following:

  • The nature of the discharge (such as whether it is watery, sticky, pus-filled, or bloody) and whether it is present most or all of the time (chronic) or comes and goes

  • Symptoms of possible causes, including fever and face pain (sinusitis); watery, itchy eyes (allergies); and sore throat, a general feeling of illness (malaise), fever, and cough (viral upper respiratory infection)

  • Whether people have allergies, diabetes, or a weakened immune system and whether they have been using decongestant sprays

If the discharge comes and goes, doctors try to determine whether it relates to where the person lives, the season, or exposure to potential triggers (such as pets or dust).

During the physical examination, doctors look at the following:

  • The face for redness over the sinuses just above the eyebrows (frontal sinuses) and the sinuses in the cheekbones (maxillary sinuses)

  • The membranes lining the nose (nasal mucosa) for color (whether they are red or pale), swelling, color and nature of the discharge, and (particularly in children) whether there is any foreign object

Doctors may also tap their finger over the sinuses to check for tenderness.

Testing

Testing is usually not needed for nasal symptoms unless severe sinusitis is suspected in a person with diabetes or a weakened immune system or with symptoms that do not resolve after treatment. In such cases, computed tomography Computed Tomography (CT) Computed tomography (CT) is a type of medical imaging that combines a series of x-rays to create cross-sectional, detailed images of internal structures. In computed tomography (CT), which used... read more Computed Tomography (CT) (CT) is usually done.

Treatment of Nasal Congestion and Discharge

The best way to treat nasal congestion and discharge is to treat the underlying disorder. There are two basic approaches to relieving the symptoms:

  • Decongestants (spray or pills)

  • Antihistamines (pills)

Decongestant sprays typically contain oxymetazoline. Decongestants taken by mouth include phenylephrine and pseudoephedrine. Decongestant sprays should not be used for more than a day or two to avoid rebound congestion.

Sale of pseudoephedrine has been restricted in some states in the United States. Pseudoephedrine can be used to manufacture a form of methamphetamine Amphetamines Amphetamines are stimulant drugs that are used to treat certain medical conditions but are also subject to abuse. Amphetamines increase alertness, enhance physical performance, and produce euphoria... read more (crystal meth) that is a highly addictive stimulant.

Antihistamines can be taken for symptoms due to viral infection and allergic reactions. Doctors often recommend diphenhydramine for people with colds. For people with allergies, antihistamines that have fewer side effects, such as fexofenadine, are used. Nasal corticosteroid sprays (such as mometasone) also help allergic conditions.

Decongestants and antihistamines are not recommended for children under 6 years of age.

Treatment in older people

Antihistamines can have sedating and anticholinergic effects (such as confusion, blurred vision, and loss of bladder control). These effects are more common among and more troublesome in older people. Antihistamines should be avoided or used in decreased dosages. Pseudoephedrine, a decongestant, stimulates the heart rate and increases blood pressure. If pseudoephedrine is needed, it should be taken at the lowest effective dose.

Key Points

  • Most nasal congestion and discharge are caused by an upper respiratory infection or allergies.

  • In children, doctors consider the possibility of a foreign object in the nose.

  • Doctors also consider the possibility of rebound congestion in people who overuse decongestant sprays.

NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
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