Why is my nose always runny?

A drippy nose from a cold or allergies usually goes away within a week or so. But what if you develop a runny nose that just never goes away? Is this cause for alarm?

We asked Otolaryngologist Aileen Kerns, DO, at Cape Cod Ear, Nose and Throat Specialists in Hyannis about the most common causes of a chronic runny nose, and the best way to alleviate symptoms.

“A runny nose means any sort of drainage from the nose,” Dr. Kerns said. “It could be watery drainage or thick mucus drainage and the term for that is rhinorrhea.”

Most of the time, Dr. Kerns tries to figure out the root cause of the rhinorrhea and then advises patients to avoid the thing that is causing the problem. A lot of times, the rhinorrhea is caused by some kind of irritation (from infection, allergies, etc.) of the mucosa. The term rhinitis means irritation and inflammation inside the nose, she said.

“A virus is the most common reason for an infectious runny nose, but another common reason is allergies,” she said.

Since allergies are so common, Dr. Kerns runs through a list of questions about the person’s environment, including:

• Describe your environment.
• Does the runny nose happen at certain times of the year?
• Is it all the time or does it get worse in the morning, or night or outside or inside?
• Is it when you visit friends or family who have pets?

The next step is to look inside the nose with a scope. Classic findings for inflammation due to allergies include dark circles under the eye (allergic shiners), itchy or watery eyes and the nose inside has a pale-boggy look to it. The drainage tends to be clear and stringy. If these symptoms are present, Dr. Kerns recommends allergy testing to identify the specific irritants so they can be avoided or treated appropriately.

Other Causes

If allergies are not a component, there is another condition called non-allergic rhinitis.

“The treatment for allergic rhinitis and non-allergic rhinitis is fairly similar with first line treatments,” she said. “And once the allergy test is negative, then we talk about other things we can do to help with the runny nose.”

Other common reasons for a constant runny nose, according to Dr. Kerns, include:

• Hormones. This is much more common in pregnant women because the increase in estrogen creates more permeability for the nasal mucosa, making it run. Puberty is another common time to develop a runny nose due to hormones and some birth control pills can have the same side effects.
• Hypothyroidism can cause inflammation in your sinuses and respiratory passages.
• A change in the vascular tone of the mucosa in the nose. This is commonly seen in the elderly. Triggers include humidity and temperature change or a reaction to dust, smoke or spicy foods.
• Exercising outdoors. This is especially true in colder weather.
• Anxiety and stress. There has been some research that links anxiety to vasomotor rhinitis.
• Side effects of medication. Typically, the medications that cause a runny nose are antihypertensive medications and some antipsychotic medications as well as the use of cocaine.
• Rhinitis medicamentosa, caused by overuse of over-the-counter nasal sprays like Afrin. This can cause rebound congestion, so people use it more, which then causes more congestion. The spray vasoconstricts the small blood vessels inside the nose, making it great to use for one or two days when you are super congested from a cold, but it loses its effectiveness with long-term use and causes this rebound effect.

If all of the above have been ruled out, treatment of vasomotor rhinitis is an anticholinergic nasal spray, like Atrovent, which would usually be prescribed by an ENT doctor. Anticholinergic spray will help reduce the amount of secretions produced, Dr. Kerns said.

The first line of treatment for regular rhinitis is a nasal steroid spray like Flonase, which simply reduces overall inflammation inside the nose. With Flonase, Dr. Kerns always advises patients to angle the tip of the nasal spray outward towards the far corner of your eye because your sinuses and turbinates are located laterally inside the nose. Never spray directly towards the septum (middle part of the nose), because the medication can irritate and dry out the septum, possibly causing a nosebleed.

For runny noses caused by allergies, she would prescribe the antihistamine nasal spray called Astelin, which is basically Claritin or Allegra in a nasal spray.

“That’s great for those runny noses that are seasonal, usually due to pollen, and for people who don’t want to go the route of immunotherapy just yet,” she said. “It’s a great topical spray. There’s no drowsiness because it doesn’t have significant systemic effects.”

In addition to various medicated nasal sprays, Dr. Kerns recommends irrigation of the nose with a saline spray. A lot of her patients can’t tolerate a Neti pot, so she recommends Ocean Saline Nasal Spray, which can be purchased over-the-counter.

“It’s only saltwater in a spray bottle,” she said. “I highly suggest that, especially when you breathe in an irritant from the environment and you want to clean out your sinuses. This will not only help the nasal mucosa filter the air that we breathe, but it cleans out all of the dust and debris that we breathe into our nose all the time. Saline irrigation can also help humidify the nose, especially at certain times of the year when the air is so dry.”

Dr. Kerns also recommends that patients use the Ocean Saline Nasal Spray before using their prescribed medicated nasal spray because it creates a nice clean slate for the medication.

More Serious Conditions

All of the conditions listed above are benign and easily treatable conditions that ENTs treat on a regular basis. But there are times when a chronic runny nose is more serious, Dr. Kerns said. Even though they are rare, patients should be aware of them.

“One of the more serious reasons for a runny nose is any history of trauma like a car accident or trauma to the head and the patient starts to have clear drainage from one side of the nose,” she said. “This is a time when you need to seek medical attention more quickly because there could be a cerebral spinal fluid leak.”

The other symptoms of a cerebral spinal fluid leak (CSF) include a salty or metallic taste on your tongue from post-nasal drip and the runny nose gets worse with any kind of exertion or baring down.

In rare instances, CSFs can also occur after sinus surgery or due to an increase of intracranial pressure in the head, called benign intracranial hypertension or idiopathic intracranial hypertension.

The other possible serious condition that can cause a persistent runny nose is a growth or tumor in the nose or sinuses. The red flags for that include frequent nose bleeds, facial pressure or pain, persistent headaches or vision problems.

“A lot of times you have to figure out the root cause of rhinorrhea and then see if it's something from the environment or inside the nose that is causing the constant drainage,” Dr. Kerns said. “It’s almost a diagnosis of exclusion where you have to eliminate all of the factors that it could be to figure out what it is.”