Assessment of

Nasal Obstruction
Medical History and Examination

Lecturer:

Emer Lang

Department of Otolaryngology,
Royal College of Surgeons in Ireland

Causes of Nasal Obstruction

Anatomical
Deviated septum
Inflammation
Allergic/vasomotor rhinitis/sinusitis
Polyps
Sarcoid, Wegeners
Neoplasia
Papilloma
SCC, nasopharyngeal carcinoma, lymphoma, angiofibroma
Foreign body
Congenital
Choanal atresia
Department of Otolaryngology, RCSI

Management of Nasal Blockage

/ Discharge

Full history / examination

Identify underlying cause
Often treat empirically
nasal

steroid spray for nasal blockage (Flixonase)

antibiotics if sinusitis suspected
nasal decongestant spray or drops (Xylometazoline)

Watch for unilateral or atypical symptoms

Department of Otolaryngology, RCSI

Suspicious Symptoms

Unilateral blockage
Unilateral epistaxis
Unilateral swelling
Neck mass
Ear effusion
Atypical pain

Department of Otolaryngology, RCSI

Septal Deviation

Symptoms
Unilateral

obstruction

Sinusitis

Treatment - septoplasty
Septal spur

Department of Otolaryngology, RCSI

Allergic Rhinitis

Seasonal / perennial
Nasal congestion,
rhinorrhoea
Atopic symptoms
Pale, swollen inferior
turbinates
+/- polyps
Skin prick tests/ RAST
identify allergen

Department of Otolaryngology, RCSI

Allergic Rhinitis - Treatment

Medical
Topical

steroid spray
Sodium Cromoglycate
Ipratropium bromide
Antihistamine

Surgery
Usually

last resort
Diathermy/ turbinate reduction
Doesnt alter disease but rather creates more space
Department of Otolaryngology, RCSI

Vasomotor / Non-Allergic
Rhinitis

Hyperactive nasal mucosa

Nonspecific stimulus
(fumes, drugs, pregnancy)
Patients complain of nasal
blockage, clear discharge after
irritant exposure
Red, boggy nasal mucosa
Skin prick tests negative
Diagnosis of exclusion
Treat

medical (empiric)
surgical (make more space)

Department of Otolaryngology, RCSI

Nasal Polyposis

Incidence 0.2-4%
Oedematous
mucosa of ethmoid
sinuses, prolapses
into nasal cavity
More common in
asthmatics

Department of Otolaryngology, RCSI

Symptoms
Nasal

obstruction
Rhinorrhoea
Sneezing
Anosmia

Examination
Pale
Boggy,

oedematous
mucosa

Department of Otolaryngology, RCSI

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Treatment Nasal Polyps

Steroids
6 mths
drops 2-3/52
oral 10 day reducing course
spray

Surgery
FESS/

Polypectomy

Recur variable time after surgery

Department of Otolaryngology, RCSI

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Unilateral Polyp

Suspicious for
tumour or fungal
sinusitis
Most common
tumour is inverted
papilloma
Look out for
meningocoele
Biopsy - mandatory

Department of Otolaryngology, RCSI

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Inferior Turbinates

Dont confuse for

polyps

Department of Otolaryngology, RCSI

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Nasal Foreign Body

Department of Otolaryngology, RCSI

Unilateral nasal
obstruction
Unilateral nasal
discharge

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Choanal Atresia

Presents at birth
Babies are obligate nose breathers for 3/12
Cyclical crying / cyanosis
Inability to feed
Test with catheter, observe mucus / fogging
Fiberoptic nasal endoscopy, CT Scan
Require secure oral airway / feeding / definitive
procedure

Department of Otolaryngology, RCSI

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Choanal Atresia

50% associated with other abnormalities (e.g

CHARGE syndrome)

Department of Otolaryngology, RCSI

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Pearls of Wisdom

Common causes of blockage/discharge

Rhinitis
Nasal

polyps
Sinusitis
Septal deviation

Biopsy the unilateral nasal polyp

Department of Otolaryngology, RCSI

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