Chronic Runny Nose: What to Do If Your Nose Won't Stop RunningNov. 9, 2022 - Katie McCallum
As a common symptom of many illnesses — a cold, the flu, COVID-19, allergies — we've all had to deal with a runny nose before.
But what about when you're constantly having to blow your nose? In some cases, for seemingly no reason.
Or maybe you've even identified the most likely times your nose starts running — say, as soon as you start eating? Is that normal?
"It's not always just a runny nose, either," says Dr. Mas Takashima, an ENT doctor at Houston Methodist who specializes in treating nose and sinus issues. "Many other symptoms are associated with chronic rhinitis, including sneezing, congestion, coughing and itchiness of the nose."
Chronic rhinitis, commonly referred to as a chronic runny nose, doesn't cause a serious slew of symptoms. But that doesn't mean they're not annoying — especially if they're constant or not going away. As such, you're likely looking for answers.
When is a runny nose considered chronic?
Rhinitis occurs when your nose is irritated or inflamed for one reason or another and, in response, produces more mucus. This mucus is meant to help trap and clear out whatever is causing the irritation, but it's also what leads to a runny nose and the accompanying symptoms.
Fortunately, this is usually temporary (called acute rhinitis) and not a huge disruption in your life. As the inflammation resolves, so does the runny nose.
Chronic rhinitis, on the other hand, is when the nose is constantly triggered, irritated or inflamed, to the point that the runny nose doesn't seem to go away or is always lingering in the background. This can certainly lead to significant quality of life issues, Dr. Takashima notes.
"Chronic rhinitis is when these symptoms persist for months to even years, despite at least a month of using medications to treat the issue," explains Dr. Takashima. "It's the people who keep facial tissue in their pockets all the time and are constantly blowing their nose. Sometimes they're even embarrassed to go out in public because of it — especially nowadays since, due to COVID-19, people are self-conscious about coughing, clearing their throat and blowing their nose around people."
What causes a constant runny nose?
The causes of acute rhinitis likely aren't surprising — a cold, the flu, COVID-19 or mild seasonal allergies.
The causes of chronic rhinitis, however, often aren't immediately clear. But the most common causes include:
- Allergic rhinitis – when allergens cause inflammation within the nose
- Acid reflux – when stomach acid travels up to the nose and irritates its linings
- Vasomotor rhinitis – a category of nonallergic rhinitis that occurs when the brain and nose have an exaggerated reaction to everyday things, such as air pollution, cold air, spicy foods or exercise, and trigger more mucus to be produced than actually needed
"Allergic rhinitis is probably the most common cause of a persistent runny nose, especially here in Houston," says Dr. Takashima. "The humidity is so high most of the year here, so mold spores are everywhere. Dust mites are, too."
Unfortunately, it's largely unclear why exactly vasomotor rhinitis happens, though it becomes more common with increasing age, Dr. Takashima notes.
There are also the less common causes of a constant runny nose to consider, too, like taking certain medications. For instance, overuse of nasal decongestant sprays can be a sneaky cause of a runny nose that won't go away.
"Viral illness can also sometimes cause a persistent runny nose or cough, as these are usually the last two symptoms to resolve after the infection is cleared," explains Dr. Takashima. "We're actually seeing a lot more of this these days due to COVID-19 — where people are dealing with a runny nose or cough for quite a while after recovery."
With all the various potential reasons for a constant runny nose, Dr. Takashima points out that fixing the issue starts with identifying what's causing it.
"Once the etiology of the rhinitis is defined, treatments vary depending on the cause," Dr. Takashima adds.
How to stop a constant runny nose
The first step to dealing with a runny nose that won't go away is to consult your primary-care doctor. He or she can get you started on some of the initial medications and therapies that are often all that's needed to help resolve symptoms, such as nasal sprays, oral antihistamines and sinus irrigation.
"For instance, these basic medications can help treat allergic rhinitis," says Dr. Takashima. "Sinus irrigation, or sinus rinse, is another great option since it clears the nose of irritants , such as allergens or environmental pollutants."
If these frontline chronic rhinitis treatment options don't work, your primary-care doctor will refer you to an ENT specialist dedicated to treating nasal and sinus issues, also called a rhinologist.
"At this point, we start delving into the potential underlying causes of rhinitis more specifically," explains Dr. Takashima.
Your ENT will ask you about your symptom history and whether you have other health conditions, using this information to narrow down the most likely diagnosis. For instance, he says that if a patient mentions their nose runs most while eating or exercising, it's a big clue that nonallergic rhinitis may be the culprit.
"In a case like that, we may try an ipratropium nasal spray, which reduces the amount of mucus your nose produces, right away and see if symptoms improve," Dr. Takashima explains.
If allergic rhinitis is suspected, an ENT specialist may recommend allergy testing and subsequent allergy shots or drops to help combat specific allergens. If acid reflux is thought to be the cause, medications to help this might be prescribed.
"We try these options and see if the symptoms improve, and, from there, we continue to manage the issue," says Dr. Takashima. "Sometimes, though, we try all these things and the patient still has a persistent runny nose. This is when we start to consider procedures."
What should you do if your nose is still runny, despite treatment?
If a chronic runny nose doesn't respond to conventional treatments and is significantly affecting a person's quality of life, procedures — and potentially even surgery — may be considered.
"We're of course always trying to find noninvasive ways to treat problems like this, but there are procedures we can perform when needed that are extremely helpful," says Dr. Takashima.
For instance, cryotherapy or radiofrequency therapy are two in-office procedures that can help treat nonallergic rhinitis.
"In either case, a small device is placed up the nose and right along the nerve that controls mucus production," explains Dr. Takashima. "Either very cold temperature or radiofrequency energy is then applied to that nerve. The treatment helps prevent the brain from inappropriately triggering the nose to produce excess mucus."
Both procedures are of minimal discomfort, short and very safe. Dr. Takashima points out that the two procedures have similar efficacy — around 65% of patients notice about a 70% decrease in the amount of drainage that they have.
"Our team has spent a lot of time researching and publishing about why chronic rhinitis happens, as well as the effectiveness of these procedures to treat it," says Dr. Takashima. "What we've found is that these in-office procedures aren't just beneficial for nonallergic rhinitis. They can also help reduce symptoms of allergic rhinitis."
This means that, rather than taking allergy shots for two to three years, some serious sufferers of allergic rhinitis may elect to have a procedure instead.
As a last resort, surgery can be considered for chronic rhinitis treatment — physically cutting the nerve supply leading to excess mucus production.
"If our in-office procedures fail, we do talk about surgery in some cases," says Dr. Takashima. "We prefer to exhaust all of our other treatment options, from noninvasive ones to the less invasive procedures, prior to recommending any kind of surgical options. But surgery can be an effective form of treatment."