Furunculosis of the nasal vestibule: causes, diagnosis, complications, treatment

Obstruction of the nose is the most common nasal symptom. It may be unilateral “more important” or bilateral.

Definition: Blockage of the nasal cavity that may or may not affect the breathing quality.

Causes of Unilateral Nasal Obstruction:

1. Congenital:

• Unilateral choanal atresia “catheter test & CT - could be accidentally discovered in older children”.
• Meningocele or meningo-encephalocele (CT & MR).
  

2. Developmental: 

• C- shaped septal deviation “ persistent not seasonal or positional”.

3. Traumatic:

• Accidental: Fractured nasal bones.
• Surgical: Adhesions.
• Foreign body: In children & mental patients. N.B. Batteries are more harmful.

4. Inflammatory: 

• Unilateral sinusitis “Fungal or that of dental origin” (CT bone & soft tissue windows).

5. Neoplastic:

• Benign: Inverted papilloma ( Biopsy).
• Malignant tumors: e.g. adenocarcinoma limited to one side (Biopsy).

6. Miscellaneous:

• Antrochoanal Polyp “usually adolescent or young adult” (CT).
• Nasopharyngeal angiofibroma, in adolescent males “epistaxis is a more common presentation”.

Causes of Bilateral Nasal Obstruction:

a. Congenital: 

• bilateral choanal atresia (emergency in newly born).

b. Developmental: 

• S-shaped septal deviation “persistent not seasonal or positional”.

c. Traumatic:

• Accidental: Fractured nasal bones.
• Surgical: Bilateral adhesions.
• Septal hematoma “may be accidental or post-septal surgery”.

d. Inflammations:

• Acute rhinitis.
• Chronic rhinitis:

      - Non-specific: hypertrophic inferior turbinates or atrophic rhinitis “loss of sensation of air flow”.

      - Specific: scleroma and lupus “either mass effect or due to atrophic changes”.

•  Acute and chronic sinusitis.
•  Septal abscess.

e. Neoplastic: 

• Large nasal tumor, which pushes or infiltrates the septum “either benign or malignant”.

f. Miscellaneous:

• Allergic rhinitis, vasomotor rhinitis and rhinitis medicamentosa.
• Bilateral sinonasal “allergic” polypi.
• Huge nasopharyngeal swellings:

      - Adenoids, in children.

      - Nasopharyngeal angiofibroma, in adolescent males “epistaxis is a more common presentation”

      - Late carcinoma, in old age.

Key points

• Unilateral obstruction is a significant symptom & should be thoroughly examined and investigated.
• Always consider the age as some pathologies are peculiar to certain age groups.

Treatment of Nasal obstruction

• Treatment of the cause is the key.
• Decongestants relieve the obstruction till management of the cause.
• Local decongestants e.g Nasal drops.
• Systemic decongestants like "Pseudoephedrine".