If your nose is clogged due to a cold or allergies, you may feel desperate for a way to clear the congestion. There are several over-the-counter remedies that decongest and help you breathe easier.
But it’s important to realize that not all congestion remedies work the same way. And some may cause unexpected—and unwelcome—side effects.
“Nasal decongestant sprays can provide quick relief for persistent nasal obstruction or congestion,” says John Craig, M.D., a rhinologist with subspecialty training in ear, nose and throat (ENT) surgery at Henry Ford Health. “They are not, however, meant to be used long term, and doing so might make the problem worse.”
How Nasal Decongestant Sprays Work
Year-round or seasonal allergies cause inflammation in the nasal passages that leads to nasal tissue swelling. This restricts airflow and makes it more difficult to breathe. “Some people also have anatomical issues that cause further obstruction,” says Dr. Craig. This can include a deviated septum (a crooked wall between the two sides of the nose) or enlarged inferior turbinates (bony structures in the walls of the nasal cavity lined by tissue that swells up periodically or with allergies or head colds).
Nasal decongestant sprays contain ingredients such as phenylephrine or oxymetazoline that constrict blood vessels in the nasal tissue lining. “They bind to the receptors on the smooth muscles around the vessels,” explains Dr. Craig. “This causes shrinkage of the tissue, which allows you to move more air through your nasal passages.”
What Is Rebound Congestion?
One problem with nasal decongestant sprays is that the effects are temporary. “When the medicine wears off, the vessels dilate and the tissues swell,” says Dr. Craig.
The bigger problem is what can happen if you continue to use these sprays more frequently in order to breathe clearly. “If you use them continuously over longer periods, you can start to experience even more swelling in the nasal passageways,” says Dr. Craig. “Over time, it doesn’t work as well to shrink them again, so you use more and it becomes a vicious cycle.”
This issue is known as “rebound congestion.” The medication shrinks the tissues in your nose to relieve congestion. But when it wears off, they swell up even more and it becomes harder to find relief.
That’s not to say nasal decongestant sprays are unsafe. Used correctly, they can be a valuable tool for coping with nasal congestion. “Generally, we recommend using them for no more than three days in a row, then take a break from them for at least two to three days,” says Dr. Craig.
ENT Care at Henry Ford
Other Nasal Spray Options
There are other types of nasal sprays that also help ease congestion. These include nasal steroid sprays and nasal antihistamine sprays.
“These types of sprays also decrease swelling in the nose, but they don’t usually work directly on the blood vessels, and they take longer to work,” says Dr. Craig. “So, they don’t lead to as much of a rebound congestion side effect.” These other sprays are generally more well-tolerated for long-term use—even years.
When to See the Doctor About Chronic Congestion
Many people live with chronic nasal obstruction. But you don’t have to. An ENT surgeon, or subspecialty-trained rhinologist, has many tools they can use to effectively treat the problem.
“If you’re using nasal spray—decongestant, steroid or antihistamine—to help you breathe better for more than a month at a time, see a doctor,” says Dr. Craig. “Get assessed by an ENT surgeon who can tell you what options you have to free you from ever needing to use spray again.”
To wean you off nasal decongestant spray, your doctor may recommend a course of nasal steroid spray (sometimes combined with an oral steroid). “If medical therapy fails, we can do surgery,” says Dr. Craig. “And it is highly successful.”
Dr. Craig and his colleagues recently published a study showing that patients using topical nasal decongestants got the same benefits from nasal surgery as those who were not using them. “This is important for patients and doctors to know, because some patients are told they cannot have surgery until they stop using nasal decongestant sprays,” says Dr. Craig. 90% of patients were still off the nasal decongestant sprays at a year after surgery.
Nasal obstruction surgery most commonly includes straightening a deviated septum or reducing the size of the inferior turbinates. This can permanently widen the inside of your nasal airways.
You don’t just have to suffer from a chronically stuffy nose in silence. Talk to your doctor to find the right treatment to help you breathe easier again.
Reviewed by John Craig, M.D., division chief of rhinology in the department of otolaryngology, and co-director of the Skull Base, Pituitary and Endoscopy Center at Henry Ford Health.
