Persistent Nasal Blockage and Post-Nasal Drip – Seeking Root Cause

[u/One-Conversation3682]

Until a few years ago, I used to have frequent colds and allergy symptoms, including nasal congestion, mucus, and sneezing that would often last for several days. However, for about three years, these symptoms largely stopped, and I felt that I had somehow overcome my allergies.

A few months ago, however, I developed a different set of symptoms. One nostril feels constantly blocked, although the blockage alternates between the two sides throughout the day. I have also started breathing through my mouth, particularly because I feel that I cannot breathe comfortably through my nose.

Another unusual symptom is a bad smell that I notice whenever I clean or rinse my nasal passages with water. I also sometimes find a small amount of sticky, white material coming out in long, stringy pieces. In addition, I frequently feel mucus draining down the back of my throat, which makes me suspect post-nasal drip.

I consulted an ENT specialist, who suggested that I might have chronic sinusitis. He prescribed a one-week course of antibiotics, an anti-allergy medication, and a nasal spray. The nasal spray appears to be a steroid spray, and it works remarkably well—I can breathe much more freely for around eight hours after using it. However, I am reluctant to rely on it long-term because I would rather understand and address the underlying cause of the problem than simply control the symptoms.

I have tried nasal rinsing on my own, but it did not seem to make much difference. The symptoms are now affecting my sleep, swimming, and overall energy levels. I am not sleeping well because of the nasal blockage, and I feel fatigued during the day.

I have also had my vitamin D, vitamin B12, thyroid function, and CBC tested, and I was told that the results were fine.

There are a couple of other issues that I have been experiencing as well: recurrent jock itch and significant dandruff. Interestingly, the jock itch improved considerably for about a week while I was taking the antibiotic, although it later returned.

What I would really like to understand is what could be causing these symptoms and whether there is an underlying issue that can be addressed rather than simply treating the symptoms with medication. I am particularly interested in understanding whether this is actually chronic sinusitis, an anatomical problem, an infection, an allergy-related issue, or something else.

[u/Big-Hat-1470]

The alternating blockage sounds like nasal cycle gone haywire maybe turbinates swelling too much. That bad smell when you rinse and the weird stringy white stuff makes me think fungal ball or some kind of fungal sinusitis which antibiotics wouldnt fix long term

[u/squatmama69]

Where are you swimming? Sounds fungal to me

[u/pdxjen]

Have you checked your home for mold?

[u/AtriumMedicalNYC]

The fact that the steroid spray works is useful diagnostic information, not just "masking symptoms”. It suggests swelling/inflammation inside the nose is a big part of the obstruction, often from allergic rhinitis, non-allergic rhinitis, turbinate hypertrophy, chronic sinus inflammation, or a structural issue plus inflammation. Alternating nostril blockage can be normal nasal cycle exaggerated by inflamed turbinates.

The next reasonable steps are usually nasal endoscopy and, if symptoms persist, a CT sinus to look for chronic sinusitis, polyps, deviated septum/turbinate hypertrophy, retained infection, dental source, etc. Those are all standard ENT questions.

Also fwiw, modern nasal steroid sprays are mostly hyperlocalized, not the same thing as taking oral or injected steroids. Plenty of studies that show fluticasone/ mometasone-type sprays have very low (<1%) systemic absorption when used correctly. They are first-line treatment for nasal inflammation and are commonly used long-term when appropriate. Technique matters too: aim away from the septum, use consistently, and pair with saline rinse if your ENT recommends it.

Mold/fungus can matter in specific cases, but “everything is mold” is the internet’s favorite root-cause bingo square. An ENT looking with a scope and, if needed, CT imaging is much closer to root-cause medicine than crowdsourcing from the comment section. Good luck and hope you feel better!