Blocked Nose

1. Anatomy
2. Definition of blocked nose
3. Hx and sign of nasal
obstruction
4. Ddx
5. Treatment

Nasal septum

Nasal airflow

Nasal Obstruction
A sensation of insufficient airflow
through the nose
Difficulty in breathing out of one or
both of the nostrils

Important History to Illicit

Onset (Sudden, gradual)
Localization (Bilateral, Unilateral)
Temporal (Persistent, Intermittent, diurnal,
seasonal)
Triggers (allergic stimuli, airborne exposures)
Past medical hx (trauma, previous nasal
surgery i.e. rhinoplasty)
Drug hx (Intranasal drug use Intranasal
cocaine)
Family hx, atopy hx

Sign of Nasal Obstruction

Inspect nasal appearance (look for
trauma, deformity)
Anterior rhinoscopy- look at entrance
for septal hematoma, septal
deviation
Proximal end of inferior turbinate

Differential Diagnosis of Blocked

Nose
MUCOSAL

INFLAMMATORY
Rhinosinusitis
Nasal polyps
Rhinitis
INFECTIOUS
HIV, syphilis, TB

STRUCTURAL

CONGENITAL
ABNORMALITIES
Choanal atresia
Pyriform aperture
stenosis
ACQUIRED ABNORMALITIES
Adenoid hypertrophy
Septal disorder
Foreign body
TUMOR

Rhinosinusitis
Symptomatic inflammation of nose
and paranasal sinuses

Acute rhinosinusitis: <4 weeks

Subacute = 4-12 weeks
Chronic = >12 weeks
Recurrent CRS =>4 episodes per
year, with each episode lasting 7-10
days

Acute rhinosinusitis
Most often caused by infectious
agent
Up to 4 weeks duration of symptoms:
Purulent rhinorrhea
Nasal obstruction
Facial pain & pressure

Common Causes for Acute

Rhinosinusitis
Viral Rhinosinusitis
Symptoms less than 10 days and not
worsening
Viruses: rhinovirus, respiratory syncytial
virus, influenza virus, parainfluenza virus

Acute Bacterial Rhinosinusitis

Symptomatic for 10 days or more
Bacteria: Streptococcus pneumoniae,
Haemophilus influenzae, Moraxella
catarrhalis

Treatment for Acute

Rhinosinusitis
Antibiotics for ABRS
Analgesia
Decongestants

Chronic Rhinosinusitis (CRS)

Inflammation lasting more than 12
weeks, with symptoms of
Nasal obstruction
Facial congestion/fullness/pressure
Discolored rhinorrhea
Hyposmia

Common Causes for CRS

Allergy
Bacterial Super-antigens
Fungi
General Host Factors

Treatment for CRS

Antibiotics
Steroid nasal sprays & oral steroids
Decongestants

Nasal Polyps
Usually due to long-standing rhinitis
PMH- allergic rhinitis, asthma
Patient presents with nasal
obstruction, rhinorrhea, anosmia
Endoscope shows pale intranasal
mass
Management: Intranasal Steroids

Nasal Septal Deviation

Patient presents with persistent
unilateral obstruction
Absent of nasal hypersecretion and
facial pain
On examination, deviated nasal
septum is seen
Management: Septoplasty

Choanal Atresia
Congenital atresia of posterior nares
Patient usually presents with
unilateral atresia
Diagnose with posterior rhinoscopy
Bilateral choanal atresia diagnose in
newborn infant emergency
Can lead to asphyxia

Adenoid Hypertrophy

Adenoid Hypertrophy
Adenoid mass is situated on posterior
wall of nasopharynx
By 15 y/o, regress
Repeated URTI result in adenoid
hypertrophy
Result in mouth breathing, snoring
Management: Adenoidectomy, esp.
in recurrent aural disease

Thank You