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.
