10 Feb When nasal spray doesn't work: What to do?
One blocked nose can have a significant impact on everyday life - be it when sleeping, speaking or simply breathing freely. Many people then turn to nasal sprays, which can provide quick relief. But what happens if the medication doesn't work? There can be various reasons for this. We explain which ones and how we can help you at our ENT practice clinic in Frankfurt.
How a nasal spray works
A nasal spray works in different ways depending on the type and active ingredient. The most common variants are decongestant, moisturising and anti-allergic nasal sprays:
Decongestant nasal sprays (alpha sympathomimetics)
They contain active ingredients such as xylometazoline or oxymetazoline, which can damage the blood vessels in the Nasal mucosa narrow. This causes the mucous membrane to swell, the nasal passages become clear again and breathing becomes easier. These sprays take effect within a few minutes and usually last for several hours.
Moisturising nasal sprays
These sprays use saline or hypertonic salt solutions to keep the mucous membranes moisturised. This is particularly helpful in dry air or with mild infections. They work purely mechanically by loosening mucus and supporting the natural cleansing function of the nose. As they do not contain any decongestants, you can use them long-term without hesitation.
Cortisone-containing or anti-allergic nasal sprays
These sprays are mainly used for allergies or chronic nasal complaints. Preparations containing cortisone reduce inflammation and swelling over a longer period of time, but only take effect after a few days. Anti-allergic nasal sprays often contain antihistamines or mast cell stabilisers, which block allergic reactions directly in the nasal mucosa.
Depending on the symptoms, a different nasal spray may therefore be useful.
What happens if the nasal spray doesn't work?
If a nasal spray no longer works as usual, this can have various causes. There are different reasons depending on the type of spray and the individual symptoms:
Familiarisation effect with decongestant nasal sprays
You should only use decongestant nasal sprays for a few days. Prolonged use can lead to your nasal mucous membranes becoming accustomed to the spray and no longer decongest properly without it (Nasal spray addiction). This can cause drug-induced rhinitis - the nose remains permanently blocked, even if there is no longer a cold.
Incorrect application
A nasal spray only develops its full effect when used correctly. Mistakes such as inserting the spray head incorrectly, pulling it up too quickly or failing to inhale briefly while spraying can result in the active ingredient not being optimally distributed.
Active ingredient too weak or unsuitable
Not every nasal spray helps with every cause of a blocked nose. For example, a mild seawater spray can moisturise a dry nose, but cannot relieve acute swelling. Conversely, decongestant sprays also do not help against allergic symptoms.
In which diseases is the nose blocked but a nasal spray is not effective or only partially effective?
If your nasal spray does not work for a long time or the symptoms persist, medical advice is required. Especially if accompanying symptoms such as headaches, a feeling of pressure in the face, frequent Nosebleed or olfactory disorders, you should make an appointment at our ENT clinic in Frankfurt for an examination.
Possible causes include
Chronic sinusitis
A chronic Sinusitis is caused by prolonged or recurrent inflammation of the mucous membranes in the pneumatisation spaces. As a result of this inflammation, the mucous membranes remain permanently swollen, which is often accompanied by increased mucus production. As the mucus cannot drain properly, nasal congestion is further exacerbated.
Decongestant nasal sprays can provide short-term relief, but do not resolve the underlying inflammation. Long-term treatment therefore requires the use of nasal sprays containing cortisone and regular nasal rinsing with saline solution. In the case of a bacterial infection, the administration of antibiotics is also useful. In particularly stubborn cases, surgery may be necessary to permanently improve the ventilation of the sinuses.
Nasal polyps
These are benign growths of the nasal mucosa that can significantly impair nasal breathing. As they mechanically block the nasal passages, decongestant nasal sprays have little or no effect. Those affected often suffer from a permanently blocked nose, a restricted sense of smell and an increased risk of infection.
Nasal sprays or tablets containing cortisone are primarily used for treatment in order to shrink the polyps and reduce inflammation of the mucous membranes. For large Nasal polyps or severe symptoms, surgical removal may be necessary.
Allergic rhinitis
Allergic rhinitis is caused by an overreaction of the immune system to certain Allergens such as pollen, house dust mites or animal hair. This reaction leads to persistent swelling of the nasal mucosa and increased mucus production, which makes nasal breathing more difficult.
Although decongestant nasal sprays can provide short-term relief, they do not tackle the actual cause of the symptoms. Sustainable treatment therefore includes the use of anti-allergic nasal sprays with antihistamines or cortisone, the targeted avoidance of allergy triggers and, if necessary, hyposensitisation in order to reduce the hypersensitivity of the immune system in the long term.
Septal deviation
One Curvature of the nasal septum occurs when the nasal septum is curved rather than straight. This causes the nasal passages to become narrower and narrower, which Nasal breathing permanently.
As the cause is anatomical, conventional nasal sprays only have a limited effect and cannot eliminate the constriction. In mild cases, moisturising nasal sprays or nasal rinses help to keep the mucous membranes supple. In severe cases, however, surgical straightening of the nasal septum (Septoplasty) may be necessary.
Nasal concha hyperplasia
One Nasal concha augmentation occurs when the turbinates - small bony structures in the nose that are covered with mucous membrane - increase in volume, making nasal breathing difficult. This can be caused by chronic inflammation, allergies or long-term use of decongestant nasal sprays. As the swelling mechanically narrows the nasal passages, conventional nasal sprays often do not help sufficiently.
Treatment options include cortisone sprays or special procedures such as nasal concha reduction (Laser conchotomy) in question.
Septal perforation
With this finding there is a Hole in the nasal septumwhich can have various causes - including injuries, chronic inflammation, excessive use of nasal sprays or the consumption of certain substances. Depending on the size of the perforation, symptoms such as obstructed nasal breathing, crust formation, frequent nosebleeds or a whistling breathing sound may occur.
As conventional nasal sprays cannot alleviate the symptoms in the long term, treatment initially consists of moisturising the nasal mucosa with nourishing nasal sprays or ointments. If the symptoms are severe, surgical reconstruction of the nasal septum may be necessary.
When the nasal spray doesn't work: Diagnostics and treatment at our ENT clinic in Frankfurt
If your nose remains blocked despite using a nasal spray, there may be an underlying cause. At our ENT practice clinic in Frankfurt, we diagnose possible triggers and determine the best treatment for your individual case.
Thanks to our comprehensive equipment, we can carry out both detailed examinations and surgical treatments directly in our practice clinic, so that all steps of the therapy remain in one hand.
Simply contact us to arrange an appointment!
Do you have any questions on this topic or would you like to arrange a consultation?
ENT Frankfurt: Dr Thomas Fischer & Dr Albrecht Linke
Your specialists for ear, nose and throat medicine, who will provide you with professional and individualised advice, examinations and treatment in all matters relating to ENT medicine, functional plastic surgery and the aesthetic treatment of changes to the facial skin.
Our news articles are prepared for you to the best of our knowledge and belief and are intended for general education. They are in no way a substitute for medical advice, diagnosis and treatment and are not intended to encourage self-diagnosis or self-treatment. Please always contact your ENT specialist in Frankfurt directly if you have any health complaints!
© "close up of sick woman using nasal spray" by Syda Productions, stock.adobe.com
English 
German 
Arabic