A blocked nose, sinus pressure, or post-nasal drip persisting weeks or months after the initial COVID-19 infection is common. This persistent issue is often categorized as chronic rhinitis or sinusitis and is a recognized symptom of post-acute sequelae of SARS-CoV-2 infection, sometimes called “long COVID.” The congestion can be frustrating and disruptive, interfering with sleep and general comfort. Understanding that this is a delayed inflammatory response, rather than a sign of failed recovery, helps focus efforts toward effective management.
Why Congestion Lingers After Recovery
The congestion results from a protracted immune response within the nasal passages. The SARS-CoV-2 virus initially causes damage to supporting cells in the olfactory and respiratory epithelium, the delicate lining of the nose and sinuses. Even after the virus is cleared, the body’s repair process can become dysregulated, leading to a state of chronic, low-grade inflammation. This sustained reaction involves immune cells infiltrating the nasal lining and releasing inflammatory signaling molecules known as cytokines.
This prolonged cytokine activity causes the mucosal lining to remain swollen and sensitive, which restricts airflow and drainage. The persistent swelling, combined with post-viral damage to the nasal lining’s natural clearance mechanisms, traps mucus and creates a feeling of intense pressure. This post-inflammatory state can persist for many weeks, leading to symptoms that mimic chronic sinusitis, including persistent sinus headaches and facial pressure. The goal of relief measures is to calm this localized, sustained inflammatory cycle.
Non-Pharmaceutical Methods for Relief
Nasal Saline Irrigation
Nasal saline irrigation is a method that uses a saltwater solution to flush the nasal cavity, which helps to loosen thick mucus and moisturize the irritated tissues. Use only distilled, sterile, or previously boiled and cooled tap water for irrigation to prevent the introduction of infectious organisms into the sinuses. The technique involves leaning over a sink and tilting the head, allowing the solution to enter one nostril and drain out the other while breathing through the mouth.
Moisture and Hydration
Steam inhalation and humidification introduce moisture directly to the airways, which helps to thin out the thickened post-COVID mucus. A hot shower or leaning over a bowl of hot water can provide temporary relief by moisturizing the nasal passages. Using a humidifier in the bedroom at night is also beneficial, with cool mist humidifiers often preferred as they may help shrink swollen nasal passages. Internal hydration is equally important, as drinking plenty of fluids ensures that the body has the water content needed to keep mucus moist and less dense, supporting the function of the tiny hair-like cilia that sweep mucus out of the airways.
Sleeping Position
Adjusting your sleeping position can leverage gravity to encourage drainage and reduce nighttime congestion. Elevating the head and shoulders by approximately 30 to 45 degrees, using a wedge pillow or several firm pillows, helps prevent mucus from pooling in the sinuses and nasal passages. This semi-upright position promotes continuous drainage throughout the night, which can significantly reduce morning stuffiness and facial pressure. If congestion is worse on one side, sleeping on the opposite side with the congested nostril facing upward can aid in localized drainage.
Over-the-Counter Treatment Options
Nasal Steroid Sprays
For congestion rooted in chronic inflammation, over-the-counter topical nasal steroid sprays, such as fluticasone or triamcinolone, are effective. These sprays work locally within the nasal mucosa to reduce the underlying swelling caused by the persistent immune response. Unlike decongestant sprays, nasal steroids are intended for long-term management and typically require consistent daily use for one to two weeks before their full anti-inflammatory effects are noticed.
Oral Medications
Oral antihistamines can be helpful if the post-COVID congestion is triggering a histamine-mediated, allergy-like response in the sinuses. Newer, non-sedating second-generation antihistamines, like loratadine or cetirizine, are generally preferred because older versions can sometimes thicken mucus, making it harder to clear. Oral decongestants, such as pseudoephedrine or phenylephrine, work by constricting blood vessels in the nasal lining to temporarily reduce swelling, offering short-term relief.
Caution Regarding Topical Decongestants
Topical decongestant sprays containing oxymetazoline or phenylephrine provide immediate relief but should not be used for more than three to five days. Prolonged use leads to a cycle of dependency and worsening congestion known as rhinitis medicamentosa, or rebound congestion. The prolonged use of these sprays causes the nasal lining to swell even more severely when the medication wears off, creating a chronic blockage that is difficult to resolve. Some natural supplements, such as the pineapple enzyme bromelain, possess anti-inflammatory and mucolytic properties that may aid in thinning mucus, but they should be discussed with a healthcare provider, especially if you are taking blood thinners.
When to Consult a Healthcare Provider
While many post-COVID congestion symptoms improve with home care, professional medical evaluation is necessary to rule out secondary infection or other complications. Consult a healthcare provider if your symptoms last longer than ten to twelve weeks post-infection, despite consistent home treatment efforts. A change in nasal discharge color to thick, opaque yellow or green, especially if accompanied by a new or recurring fever, may indicate a bacterial sinus infection requiring antibiotics. Worsening facial pain or pressure localized to the teeth or eyes, or a severe headache that does not respond to over-the-counter pain relievers, also warrants a medical visit.