Anyone who has suffered with a severe cold knows how miserable life can be with a blocked nose. Sleep is difficult, the mouth gets dry, smell and taste are poor. There is often a feeling of congestion in the cheeks. Although a cold usually lasts for no more than a few days and can therefore be tolerated, constant nasal obstruction can lead to long term problems. As well as the above symptoms can be added snoring and even sleep apnoea (see obstructive sleep apnoea page). Oral hygiene is difficult due to the lack of saliva in the mouth. This produces dental caries and bad breath. Poor sense of taste and smell can be a depressing long term problem.
Causes of Nasal Obstruction
These can be due to
- Inflammation of the lining of the nose (rhinitis or rhinosinusitis)
- Swellings within the nose – usually polyps
- Structural problems in the nose either caused during development or secondary to trauma
- In children foreign bodies can be the problem. This is rare in adults
The cause of the problem is of course important to establish as without this the correct treatment can only be guessed at.
The important questions to ask are:
- Is the obstruction constant or intermittent?
- If intermittent does it vary at different times of the day (diurnal) or is the variation seasonal?
- Are other symptoms present such as pain, nasal discharge, sneezing etc?
- Is the problem worsening, staying the same or does it vary?
Depending upon the answer to these questions, the possibility of a fixed or transient obstruction can be ascertained. It is important however to examine the nasal passages and nasopharynx (the area between the nose and throat). It is also useful to examine the voicebox (larynx) as this can show signs of changes caused by sinonasal problems.
Patients should therefore be evaluated by a full history followed by an endoscopic visualisation of the nose and upper airway (fibreoptic nasolaryngoscopy). This can all be performed in an outpatient consultation. Following this, treatment can be commenced if the problem is medical. If the problem is structural or due to an obstructing lesion, the type of operation needed can be discussed. This will sometimes require a scan of the nose before surgery.
Other tests sometimes required include:
- Skin prick testing for allergies
- Various blood tests depending upon findings at endoscopy
If you would like to arrange a consultation with Mr Banerjee to look into this condition further please contact us.