The Blocked Nose

Remit

A brief review of the causes of a blocked nose is presented. Details of the diseases discussed can be found elsewhere.

Think logically

The simplest way to remember the basics of the blocked nose is to recall the tissues within the nasal cavity that may cause obstruction. In fact there are only two tissue of importance: the nasal mucosa and the nasal skeleton (cartilage and bone). Remember also the adenoids. Strictly these are not in the nose but in the nasopharynx however, they are included here as a cause of nasal blockage.

Any disease that causes swelling in the nasal mucosa will cause a blockage. The commonest of these is rhinitis in its various forms. The commonest cause of acute rhinitis is viral - the common cold. We are all familiar with the effect of this on our breathing. Allergic rhinitis also causes nasal obstruction, whether it's seasonal or perennial.

There are 3 other main causes of nasal obstruction:

1. Nasal polyps are also a cause. Read the section on polyps for further information. Tumours are also a cause but are very uncommon.

2. The adenoids are a collection of lymphoid tissue that arises in the roof of the nasopharynx. It is large in childhood and is a common cause of obstruction in children. It is much less common in adults.

3. Deviations of the nasal septum also cause nasal obstruction and this may be unilateral or bilateral. They are frequently idiopathic in origin but facial trauma also causes them. The turbinates may be large or deformed and contribute to obstruction.

Normal

Deviated nasal septum

Rhinitis

Nasal polyps

A patient comes to you with a blocked nose...

As always start with a good history. If the blockage started after a blow to the nose it is likely that there will be an element of skeletal change that is causing it such as a deviation of the septum or some displacement of the nasal bones.

If there is no antecedent trauma it is likely that a mucosal cause is present; rhinitis being by far the commonest cause of this.

If there is unilateral blockage and bleeding, numbness or swelling in the face, or double vision (all red flags for possible malignancy in the nose) refer immediately for further opinion.

Bilateral problems are seldom caused by dangerous disease.

If you are happy that there is nothing serious present, prescribe a nasal steroid spray. This should be used daily with a head-down posture ("Look at your toes when you spray the nose!"). Use these continually for three months and reassess.

 

It isn't very important which nasal steroid you use but general principles suggest that compliance is better with once daily applications.

Should this fail, refer for an opinion.