Have a Stuffy and Runny Nose? Here’s What Causes It and How to Treat It

An expert explains what's going on in the nose and why we get the sniffles.

Whether it’s a winter virus, pollen in the spring, or ragweed in the fall, everyone experiences seasonal sniffles. While allergies are the most common culprit, stuffy or runny noses are also characteristic of colds, COVID-19, and the flu. In many cases, it can be confusing to tell what is actually causing the congestion.

“Almost every breath of air we take first passes through the nose, and it is the front line of our immune system,” says Dr. David A. Gudis, an otolaryngologist and chief of the Division of Rhinology and Anterior Skull Base Surgery at NewYork-Presbyterian/Columbia University Irving Medical Center. “When a germ or microbe is identified as a threat, the lining of the nose and sinuses mount a protective response that includes inflammation and production of secretions. These changes are experienced as stuffy or runny noses.”

To learn all about runny and stuffy noses and how to treat them, Health Matters spoke to Dr. Gudis, who is also an associate professor of otolaryngology – head and neck surgery at Columbia University Vagelos College of Physicians and Surgeons.

Dr. David Gudis

What causes a stuffy or runny nose?
Dr. Gudis: Not only is the nose for breathing, the sense of smell and taste, it also protects us from countless microscopic threats. Whether you are in a rainforest or a desert, a dusty field or a clean office, in winter or summer, the air that passes through your nose with every single breath is highly filtered and within a narrow range of temperature and humidity — even before it reaches your windpipe and lungs. That’s a lot of work for a nose to do, and that’s only the beginning. The lining of the nose (or mucus membrane) then changes depending on the world around us. If there is an allergen or virus, the nose reacts by becoming inflamed and runny.

How can you tell if it’s an allergy, a cold, or a virus causing your stuffy nose?
Whether you have a cold or something else, doctors call runny and stuffy noses “rhinitis.” Allergic rhinitis is usually characterized by clear, watery nasal discharge, itching, and sneezing, and it is generally in response to specific environments or seasons. If your symptoms occur when you first step outside in the winter, you may have vasomotor rhinitis, which is not a serious condition but can impact quality of life. And the best way to find out if the symptoms are related to COVID-19 or the flu is to get tested.

How do you know when a stuffy or runny nose is something more serious?
Most stuffy and runny noses are caused by viruses and will resolve on their own. If your symptoms last more than a week or are accompanied by others — like fever, nausea, vomiting, or pain — it is worth seeing a doctor. In addition, you may want to see a specialist if your runny and stuffy nose is a long-standing chronic condition or associated with persistent sinus pain, pressure, or discolored mucus.

Are some people more susceptible to them than others?
Yes. Some chronic conditions, such as allergic rhinitis, can cause people to have stuffy or runny noses more often. An abnormal anatomic structure — like a deviated nasal septum (when the wall in the middle of the nose that separates the left and right side is crooked) — may obstruct airflow on one or both sides of the nose and cause chronic stuffiness. Also, some people are prone to chronic sinusitis, which can cause thick or discolored mucus to form and cause stuffiness.

How do you treat a runny and stuffy nose?
If the stuffy, runny nose is due to a virus, rest is best! There are many kinds of nasal sprays, some of which are over the counter. It is generally safe to use nasal saline spray (saltwater) or nasal corticosteroid sprays (like Flonase/fluticasone). If you are pregnant or have any other medical conditions, it is best to speak to your doctor before taking the corticosteroid sprays. Over-the-counter nasal decongestant sprays (like Afrin/oxymetazoline) can have side effects, and they can also cause “rebound congestion,” where the lining of your nose becomes more congested and dependent on the medication.

Does the color of the mucus mean you have an infection?
Thick and discolored (yellow or green) mucus usually represents an infection, but contrary to popular belief, the color of mucus does not indicate that you need antibiotics. Viral infections of the nose and sinuses can also cause similar nasal discharge to occur.

Are running and stuffy noses more common in children?
Yes, and especially when they are in day care or preschool.

Are there other things you can do to prevent a runny nose?
Wash your hands!

David Gudis, MD, FACS, FARS, is chief of the Division of Rhinology and Anterior Skull Base Surgery in the Department of Otolaryngology–Head and Neck Surgery and the Department of Neurological Surgery at Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian/Columbia University Irving Medical Center.   

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