General Medical Information

Specific Etiologies Of Nasal Obstruction

Richard L. Mabry

Strategies for the management of nasal obstruction are based primarily on the history, physical examination findings, and results of laboratory tests, where applicable. More involved diagnostic studies, such as biopsy or computed tomography (CT) of the sinuses, can be used to confirm the original diagnosis and help plan treatment, such as the extent of surgical excision. They also help define the anatomic and pathologic characteristics of the paranasal sinuses. Alternative diagnoses must be kept as contingencies in the event of treatment failure.

Management of nasal obstruction can be divided into three general areas: medical intervention, surgical intervention, and a broad “other” category. In executing a treatment plan, the physician must remember the simplest explanation or treatment strategy is the correct first approach to nasal obstruction for the patient at hand. The physician should consider management of nasal obstruction a span of treatments, including no treatment or a minimally invasive approach, such as removal of the irritant or observation; medical management, such as oral decongestants, oral antihistamines, corticosteroid nasal spray, intraturbinal steroid injection, antibiotics, topical ointments; and surgical procedures, such as septoplasty, nasal valve repair or augmentation, submucous resection or ablation of the nasal turbinates, and resection or removal of any neoplasms or obstructive anatomic structures.

Obstructive anatomic features, such as a deviated septum or neoplasm, are treated primarily with surgery, whereas obstructive abnormalities that cause nasal obstruction, such as turbinate mucosa hypertrophy, are managed surgically only after failure of aggressive medical treatment. Surgical management of nasal obstruction usually includes procedures on the septum (submucous resection or septoplasty), septum and outer cartilaginous support of the nose (septorhinoplasty through the internal or more commonly the external approach), turbinate bones (submucous resection or partial turbinectomy), turbinate mucosa (mucosal ablation by means of electrocautery, laser, or cryotherapy), or neoplastic tissue (surgical debulking and removal).