Vincent Cumberworth BSc FRCS Consultant Ear, Nose and Throat Surgeon
Clementine Churchill Hospital Sudbury Hill Harrow Middlesex HA1 3RX
Private Secretary: Tel: 020 8872 3866 Fax: 0208872 3861

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Nasal Obstruction 

The sensation of a blocked nose is often referred to as nasal obstruction, a stuffy noise or nasal congestion. The severity of the nasal obstruction varies; some people find even mild nasal blockage quite troublesome, whereas for others, with quite severe nasal obstruction, it does not present a significant impact on their daily activities.   The severity of the symptoms will be considered when planning treatment.

Nasal obstruction can be due to problems with the shape of the interior of the nose, or swelling of the lining of the inside of the nose. Problems with the interior shape can be due to twisting of the middle partition of the nose (the nasal septum), or to weakness of the outside of the nose, where the cartilages are weak and the reduction of pressure on breathing in through the nose leads to partial collapse of the margin (“alar collapase”).

Either of these may be associated with abnormalities of the shape of the outside of the nose. Occasionally other structures, such as the adenoids, can be enlarged contributing to nasal obstruction. The noise is lined by a thin mucous membrane which can swell to cause blockage and structures on the lateral (side) wall of the nose, covered by mucous membrane, called turbinates are particularly prone to swelling.  Such swelling occurs in response to a common cold, when the lining swells in response to a viral infection.

Swelling of the lining of the nose is often termed “rhinitis” and it can have many causes. Apart from viral infections, rhinitis may be due to bacterial infection in the nose and sinuses, allergy, or overuse of nasal decongestant medication. Occasionally the mucous membrane swells enough to cause the formation of polyps in the nose.  Swellings such as polyps inside the nose can markedly increase blockage and other secondary nasal symptoms.

Nasal obstruction may be accompanied by other symptoms such as rhinorrhoea (nasal discharge, which can drip from the front of the nose, or into the back of the throat – catarrh), facial pain, anosmia (loss of sense of smell), sneezing, itching and crusting. Accompanying symptoms need to be diagnosed and considered when making a diagnosis and developing a plan for treatment.

Mild nasal obstruction may not require any treatment. If symptoms are short lived, lasting only a few days to a couple of weeks, there may be a response to over-the-counter medication such as a decongestant nasal spray.

Sometimes it is soothing to breathe in steam, or vapours such as menthol and eucalyptus. Saline drops or sprays, or other nasal douching preparations from a pharmacist may also be used to help clear sticky mucus from the nose.

For symptoms caused by seasonal allergy, which are mild and intermittent, an antihistamine tablet may help. For nasal obstruction due to collapse of the outside of the nasal tip, wearing an adhesive dilating strip may be helpful, particularly at night.

A specialist may examine the nose with the help of a head light or an endoscope (a thin telescope with a camera), a procedure which is performed using a local anaesthetic spray but which may be mildly uncomfortable.  Occasionally other tests to help clarify the cause of symptoms; common tests include blood tests, skin tests for allergy, and imaging studies such as CT scan of the nose and sinuses.

The treatment options for a blocked nose depend on the underlying cause and severity of symptoms; they include medication and surgery. If the cause of nasal obstruction is rhinitis a course of medication such as intranasal steroid spray, antihistamines or decongestants, may help. In some cases it is necessary to take the medication for several weeks before any improvement ensues in symptoms.

If the cause of nasal obstruction cannot be treated by, or does not respond to medication, an operation may be considered. The type of operation performed depends on the underlying cause of a blocked nose. Operations include: septoplasty to straighten the nasal septum, rhinoplasty to straighten the outside of the nose and turbinate surgery to reduce the swollen folds of mucous membrane. Blockage caused by persistent, or recurrent infection in the sinuses may be relieved by sinus surgery, typically performed endoscopically. Adenoidectomy (surgical removal of the adenoids) can be performed or enlarged adenoids and polyps may be removed independently or as part of other procedures

It may not be possible to completely cure nasal obstruction with medication or even surgery; people often find that even after an operation they must continue to take medication to achieve the best control of their symptoms.

The cause of nasal obstruction is often complex involving many different factors. Some causes of nasal obstruction do not respond as well as others to either medication or surgery; occasionally symptoms do not improve, or may recur months or years after surgery. Any operation carries the risk of developing complications.

Almost any operation on the nose carries a small risk of bleeding or infection; specific complications related to an operation will be discussed by the specialist and are listed in information sheets.