Nasal Obstruction

The sensation of unilateral or bilateral nasal obstruction is relatively common and can range from mildly annoying to extremely frustrating to the patient. Nasal obstruction may be associated with other symptoms such as rhinorrhea, lost or altered sense of smell, or facial discomfort. Nasal obstruction may result from pathology of the nasal cavity or nasopharynx. (eTable 19-4 online summarizes the most common causes, associated signs and symptoms, and treatment for nasal obstruction).

Physical Examination

See the discussion online at www.expertconsult.com. Treatment

Successful treatment of nasal obstruction depends on making a correct diagnosis. Once the diagnosis has been established, a treatment plan should be developed. If the nasal obstruction is secondary to one of the various types of rhinitis, it is treated medically. This includes nasal steroids, antihistamines, leukotriene inhibitors, mucolytics, oral decongestants, topical decongestants, and nasal saline. These medications may be used alone or in various combinations. The choice of medications is determined by the severity of symptoms and the patient's medical history, response to treatment, and wishes. Oral steroids can be used in select severe cases but are associated with potential significant side effects. Nasal decongestant sprays are very effective for treating severe nasal congestion but should be used sparingly and never for longer than 3 days, to prevent rebound nasal obstruction (rhinitis medicamentosa). Allergy testing is done when allergies are suspected and the standard regimen is largely ineffective. Antibiotics are administered if a bacterial infection is suspected (acute rhinosinusitis).

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