NASAL OBSTRUCTION

Meng Juan
OTOLARYNGOLOGY DEPATMENT

WEST CHINA HOSPITAL

Definition

 It is the subjective sensation of nasal

breathing difficulty or blockage.

 This subjective sensation can be

measured objectively by rhinometery.
 Nasal Cycle
 Is a spontaneous cycle of nasal congestion and
decongestion .
 The nose has period in which one side of the nose
becomes congestion. During the same period the
other side of the nose remains patent.
 Lasts from three to six hours
 Is known to be regulated by the sympathetic and
parasympathetic system (ANS).
 pathological nasal congestion

 However, any anatomic variations or functional

changes of mucosa may resist airflow and produce

partial or complete nasal obstruction.

Etiologies of nasal obstruction
The most important causes of nasal
obstruction are:
1. Congenital:
congenital choanal atresia/nasal septum deviation
2. Traumatic :
nasal bone fracture/ nasal septum hematoma or
deviation
3. Foreign body in the nose.
Etiologies of nasal obstruction
The most important causes of nasal
obstruction are:
4. Inflammatory:
rhinitis: allergic rhinitis /acute rhinitis/ chronic
rhinitis/ atrophy rhinitis
rhinosinusitis :acute /chronic
5.Neoplasm:
benign: nasal polyp/inverted papilloma
malignant: nasal pharyngeal carcinoma
Etiologies of nasal obstruction
Other causes of nasal obstruction
include(Non-anatomic abnormalities ):
 overuse of nose sprays (ephedrine)
 birth control pills/pregnancy
 Hypothyroidism
 Empty nose syndrome
 Congenital
Choanal atresia

 back of the nasal cavity is blocked during the fetal

development.

 other abnormalities: heart defects, mental retardation,

growth impairment.

 unilateral: detected much later

bilateral : serious life-threatening condition
Congenital
 Congenital
Atresia of the posterior nares

After transplatal repair Endoscopic examination

silica gel pipe fill in surgical cavity New posterior choanal shaping
 Congenital
Nasal septum deviation

-congenital disorder perpendicular plate

of ethmoid bone
-impact trauma
septal cartilage
vomer
Congenital

Deviated Nasal Septum

Congenital
 Congenital
Nasal septum deviation
 nasal obstruction:
ipsilateral or bilateral
perpendicular plate
 snoring or sleep apnea
of ethmoid bone
 nasal bleeding
septal cartilage
 Headache
vomer
 loss of smell
 rhinosinusitis
Congenital
Nasal septum deviation
 Foreign body in the nose

 Most cases occur in young children

 can be without symptom for a while
 Produces an inflammatory reaction
 nasal obstruction, unilateral purulent
rhinorrhea or nasal bleeding
 Formation of granulation tissue and
ulceration
 Some time a rhinolith may form
 Rhinitis

 Acute rhinitis---rhinovirus, influenza virus

 Chronic rhinitis---repeated acute rhinitis /irritation
---simple/hypertrophic

Before turbinoplasy After turbinoplasy

Radiofrequency ablation
 Rhinitis

 Allergic rhinitis- allergen

 Atropic rhinitis
characterized by atropic changes of the mucosa, including the
glands, turbinate bones and nerve supplying
----Primary: heredity, Vitamin deficiency,
endocrine disorder
often involve women
----Secondary:
too much mucosa are
damaged during surgery
 Adenoid hypertrophy

 is most common among

children
 Is a nature during development
 Most have no symptoms

 may result in nasal obstruction,

 Snoring during sleep

 Neoplasms (benign)
Nasal polyp
 associated with AR and asthma.
 grey or pale polypoid mass
 nasal obstruction
reduce of the smell
runny nose
 Neoplasms (benign tumors)
 nasal inverted papilloma
---benign epithelia tumor
---locally aggressive
---recur after surgery
---change to malignant

 Hemangioma
---Vascular tumor arises in the nose
---nasal obstruction
---nasal bleeding
 Neoplasms (malignant tumors)

 Nasopharyngeal carcinoma

 Malignant tumor in the nose

(squamous cell carcinoma, olfactory neuroblastoma, malignant melanoma)
 Empty nose syndrome

 is a rare clinical syndrome in which people who have clear

nasal passages experience a range of symptoms, most
commonly feelings of nasal obstruction, dryness and
crusting, and a sensation of being unable to breathe

 usually undergone a nasal surgical procedures

 There are no objective physical examination findings

 Evaluation of nasal obstruction

 Evaluation begins with a history, and

physical examination.
 Because the cause of nasal obstruction can
be variable, the doctor must be familiar
with the various manifestations to ensure an
accurate differential diagnosis.
 History
must pay attention to:
 duration of symptoms
days: acute inflammation, foreign body
months: chronic inflammation , neoplasm
years: chronic inflammation
 History
must pay attention to:
 Bilateral or unilateral
-- Unilateral :obstructive anatomic abnormality,
（neoplasm or deviated septum）
-- Bilateral: systemic cause (rhinitis）
 History
must pay attention to:
 Persistent or intermittent
Intermittent:
AR, acute sinusitis
persistent with remission and exacerbation:
chronic inflammation
steady progress:
neoplasm
 History
Nasal obstruction with other manifestitations
 Nasal deformity:
 trauma / deviation of the septum/tumors
 Attack of sneezing and discharge:
 AR/ WMR
 Epitasis:
 nasopharyngeal carcinoma
 Bloody smelly discharge
 foreign body
 Physical Examination

anterior rhinoscopic examination

(nasal polyps result in obstruction)
 Physical Examination

Nasal endoscopic examination

(nasal inverted papilloma occupy inferior meatus)
 Test

Computed tomography
is the most helpful
auxiliary test for nasal
Obstruction.

FIGURE 28
 Test
Subject assessment of the obstruction:
Rhinomanometry
 Test
Subject assessment of the obstruction:
Acoustic rhinometry
麦克风
发声器

鼻腔结构探头
 Highlights
 Nasal obstruction is one of the most common symptoms
in otolaryngologic practice.
 In addition to the history, physical examination of the
nose by means of direct and endoscopic visualization
discloses most cases of nasal obstruction and allows con-
firmation through tests for common causes of nasal
obstruction.
 Highlights

 Computed tomography of the sinuses is the

most helpful auxiliary examination for
evaluating nasal obstruction.

 Neoplasms are uncommon causes of nasal

obstruction, but they must be ruled out.