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Nasal Obstruction causes and 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: 

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

4. Inflammatory: 
  • Unilateral sinusitisFungal or that of dental origin” (CT bone & soft tissue windows).

5. Neoplastic:

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: 

b. Developmental: 

c. Traumatic:

d. Inflammations:

      - 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”.

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".


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