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Nose block in Adults
Written By: Dr Ibrahim Issa MD. Otolaryngology Consultant , Laryngologist & Phonosurgeon.
Edited By: Dr Mohammad Murad MD. Otolaryngology Specialist.
Your nose is like you car that you have used to it for a very long time, you might think it’s a very good car and that all cars are the same as yours till you rent a new large engine car, then you will notice the difference and you will start thinking that you might have problems with your own car. Because you didn’t have another nose since you were born you might under estimate your nose block severity. I usually get amused with patient’s neglect to their nose problems especially the chronic problems while coming to my service asking for treatment for many complaints that are actually just a complication for their nose block, including headache, ear pain, decrease hearing, loss of smell, snoring, and many other symptoms, and when I ask them if they have nose block; they say no, my nose is always open!
Causes of nose block in adults:
1/ acute rhinitis: which is a viral or bacterial infection that causes generalized congestion and edema of the nasal and sinus mucosa that tightens the air passages of the nose.
2/ allergic rhinitis: which is an allergic reaction of the nasal and sinus mucosa to an allergen that might be anything like dust, smoke, perfumes, pollens or food.
3/ large turbinates: turbinates are part of the nasal structures that are present normally in all people. Inflammation may cause enlargement of these turbinates making the nasal cavity narrower, a problem that might be temporary or prolonged. (See polyps Vs adenoids Vs turbinates).
4/ septal deviation: the nasal septum is the wall that separates the nasal cavity into right and left, it’s a cartilaginous and bony wall that is covered with thin mucosa. Deviation of this septum is a very common thing and might not cause any problem, but sometimes if the deviation is sever or occurs in an important area of the airways, it will cause narrowing of the nasal air passages. (see septal deviation article)
5/ nasal polyps: nasal polyps are benign masses that are formed from the thickening of the sinus mucosa and expand to go out of the sinus cavities to the nasal cavity causing nose block.
6/ other rare causes like nasal tumors and foreign bodies.
Assessment of patients with nasal block includes detailed history of the problem and examination of the nose, throat and ears. Nasal endoscopy is considered part of the detailed examination and is mostly needed to have a complete view of the problem picture. If endoscopy of the nose was not complete due to sever anterior block by septal deviation for example we usually need to do and CT scan of the sinuses, because incomplete evaluation will lead to partial diagnosis and non sufficient treatment. For example, doing a surgery for a patient to correct a sever anterior septal deviation might end up with no change in the nose block if a nasal polyp was present posterior to the deviation site and was not seen and removed, and the patient will need another surgery to remove it.
After complete assessment; all factors affecting the nasal passages should be collectively considered and treated starting with the least invasive methods including medical therapy and if this fails then some factors could be tackled surgically. Although some factors like septal deviation are mechanical problem that could not be corrected with medical treatment, we can try a short course of nasal spray that might make some help to decrease the surrounding mucosal congestion and so widen the nasal passages without causing any harm by delaying the surgery for one or two weeks.
Written By: Dr Ibrahim Issa MD. Otolaryngology Consultant , Laryngologist & Phonosurgeon.
Edited By: Dr Mohammad Murad MD. Otolaryngology Specialist.
