And sometimes the cause is a bit of a mystery.
But sinus woes such as a runny or congested nose, sneezing or postnasal drip are common. Other problems might include facial pressure, a reduced sense of smell or taste, a crusty nose and feeling like you often need to clear your throat. And older adults are more susceptible to trouble with these air-filled cavities behind the nose, cheekbones and forehead.
“Your nose changes as you age,” says Kevin Hur, an assistant professor of clinical otolaryngology at Keck Medicine of USC in Los Angeles. With age, the nose becomes less efficient at moving mucus out, trapping it there and in the sinuses — and allowing congestion and other unpleasant symptoms to linger.
Here are some common sinus culprits and how to handle them.
Respiratory ills and allergies
Up to 30 percent of adults experience a stuffy or runny nose because of allergies to substances such as tree, grass or weed pollen, as well as mold, pets, dust mites and cockroaches, says allergist Zachary Rubin, a spokesperson for the American College of Allergy, Asthma and Immunology.
And older adults tend to have less robust immune systems, which makes them more prone to colds and flu, says Hiten Patel, a family medicine specialist at Ohio State University Wexner Medical Center in Columbus. Both can cause sinus trouble.
What to do: Over-the-counter saline nasal drops or saline rinses are your best bet in either situation, Hur says. When you’re stuffed up, use these several times a day to help flush out mucus. “It’s like taking a shower — you can’t do it too much,” he says. You can even do this preventively, such as once or twice a day during cold and flu season. “It helps keep them [your sinuses] moist and healthy, and may help clear out any viruses that can cause a cold,” he says.
For a respiratory virus that’s causing sinus woes, you can also use an over-the-counter steroid nasal spray such as fluticasone (Flonase) or triamcinolone (Nasacort) for a couple of weeks. This can help reduce nasal inflammation from the virus, Hur says.
For allergies, an OTC antihistamine nasal spray such as azelastine is a better option, Rubin says, and it can quickly relieve congestion. If this doesn’t help, ask your doctor about the prescription Dymista, which combines a nasal antihistamine with a steroid.
For both, an OTC nasal decongestant spray like oxymetazoline (Afrin) may provide some relief. But using these for more than three days hikes the risk of rebound congestion, Hur says. And be cautious about oral decongestants, which may have ingredients such as phenylephrine that can raise blood pressure, Patel says.
If the above strategies don’t help after about 10 days of a respiratory infection, or you begin feeling better and then worse, consider having your doctor check for a bacterial sinus infection, especially if you also have facial pain and pressure, a cough, and a low-grade fever. You may need an antibiotic, Hur says. For lingering allergy-related sinus symptoms, ask about immunotherapy (given as shots or, for some allergens, sublingually, a.k.a. under the tongue).
When the cause is less clear
Nonallergic rhinitis — caused by irritants such as cigarette or fireplace smoke, traffic fumes, strong odors, and weather changes — also can cause sinus trouble. “It’s due to a dysregulation of the nerves in your nose that make mucus,” Hur says.
Stuffiness that’s accompanied by a dry, crusty nose or even nosebleeds may signal what’s called atrophic rhinitis. “As you age, your nasal tissue thins and atrophies, due to decreased blood flow to the nasal cavity,” says Peter Manes, an ear, nose and throat specialist at Yale School of Medicine in New Haven, Conn. “Cartilage weakens, too, which can change the shape of your nose.”
What to do: If you suspect that you may have nonallergic rhinitis, avoid potential triggers and use saline nasal spray several times a day to flush out mucus and irritants. Need more help? The prescription nasal spray ipratropium (Atrovent), which reduces the amount of mucus you produce, is useful for a primarily runny nose, Manes says.
For a stuffy nose, antihistamine nasal sprays are often quite effective. “It’s most likely because they have some sort of anti-inflammatory effect, and they may also calm down nerve endings in the nose,” Manes says. Treatment for atrophic rhinitis usually involves spritzing your nose frequently with saline nasal spray.
Sinus trouble still won’t quit?
If you don’t feel better within a few weeks after trying some of the treatments above, it may help to have an ear, nose, and throat specialist examine your nose with an endoscope.
“This allows us to look for mucus that could indicate infection, as well as swelling or even nasal polyps, benign growths on the lining of your nasal passages,” says Gregory Levitin, an otolaryngologist at New York Eye and Ear Infirmary of Mount Sinai in New York. Sometimes, the solution is simple. For nasal polyps, for instance, the injectable prescription drug dupilumab (Dupixent) may help shrink them.
But if the cause of persistent nasal symptoms isn’t straightforward, you may need a CT scan of your sinuses. “Sometimes, years of untreated inflammation has damaged sinus tissue,” Levitin says. “This can lead to chronic inflammation and swelling.”
A small amount of such tissue can be removed in your doctor’s office, but more extensive sinus disease may require surgery done under general anesthesia. This is considered relatively safe for older adults: In a study published in the American Journal of Rhinology & Allergy in 2022, the rate of surgical complications was 3.9 percent for adults 70 and older, but it was higher — 8 percent — for younger patients.
- A steamy shower: The warm, moist air will help mucus drain, Manes says. You can also drape a towel over your head and breathe in steam from a bowl of hot water.
- Staying hydrated: Both hot and room temperature drinks help ease nasal symptoms, found an older study in the journal Rhinology. But people reported more relief from sipping a hot drink than a room temperature one. Another older study found that chicken soup and hot water relieve cold symptoms like nasal congestion more than cold water did.
- Chile peppers: These are rich in capsaicin, which may help relieve nasal congestion, according to a 2015 Cochrane review.
- A humidifier: Dry air can irritate and inflame the nasal lining. A humidifier (opt for cool mist) set at 30 to 50 percent humidity will increase moisture in your home appropriately, Manes says.
- Chronic heartburn: In gastroesophageal reflux disease (GERD), stomach acid regularly backs up into your esophagus and mouth, damaging the esophageal lining. The most common tip-off is a persistent sore throat or cough, Hur says. But in a study published in BMC Pulmonary Medicine in 2021, GERD was also associated with a fourfold increase in nonallergic rhinitis. “We tend to see this in patients with severe GERD” who may not realize the condition is also affecting their sinuses, Hur says. A gastroenterologist can help.
- Obstructive sleep apnea: People with this condition (where breathing stops briefly numerous times during slumber) who also reported nighttime nasal congestion were more likely to have severe OSA, according to a 2022 study. They also were more likely to have high or uncontrolled blood pressure. Dealing with issues that may get in the way of OSA treatment — like a deviated septum or other structural obstructions in the nose — can help your sinuses too, Hur says.
- Medication side effects: Beta-blockers, antidepressants and erectile dysfunction drugs may worsen nasal congestion. If you suspect this, talk to your doctor. You may be able to switch to a different class of medications.
Copyright 2024, Consumer Reports Inc.
Consumer Reports is an independent, nonprofit organization that works side by side with consumers to create a fairer, safer, and healthier world. CR does not endorse products or services, and does not accept advertising. Read more at ConsumerReports.org.
