Nasal Obstruction

What is Nasal Obstruction?

Nasal obstruction refers to the partial or complete blockage of the nose  or nasal cavity.The nasal cavity starts at the nostrils and ends at the back of the throat.

What are the symptoms of nasal obstruction?

Nasal obstruction may be apparent in a  newborn with difficulty in breathing or noisy breathing.

An older child with nasal obstruction may have a runny nose, snoring, breathe through the mouth or produce a raspy noise when breathing.

What causes nasal obstruction?

Common causes of nasal obstruction include:

Swelling of nasal turbinates can cause blockage of the nose. The inside walls of the nose have three pairs of long thin bones that are covered in spongy tissue. These bones are called nasal turbinates. The turbinates can swell when affected by allergies and or prolonged viral infections. When they swell the nose gets blocked making it difficult to breathe.

Deviated nasal septum. The nasal septum is the bone and cartilage that separates the nostrils in the middle. When it is crooked or displaced off the middle it may make breathing difficult. Some people are born with a deviated nasal septum.In some the septum gets deviated following injury to the nose. Commonly the deviation causes one side of the nose will feel more congested. Other problems that may be noticed include nose bleeding, pain on the face, headaches, loud breathing and snoring.

Foreign bodies. Objects may get lodged into the nose either if it is inserted by the child during play or accidentally. Objects that are commonly inserted include seeds, tiny toys, pieces off crayon, erasers, paper wads, cotton, beads, button batteries etc. A child with a foreign body in the nose may find it difficult to breath through the affected nostril. There may be pain or a feeling of discomfort in the nose. The nose may become infected leading to smelly nasal discharge that may be blood stained. Infants may be irritable.

Choanal atresia. This is a problem a child may be born with where the back of the nasal passage is blocked by abnormal bone or soft tissue. This happens when the nasal passages fail to open up during fetal development. It can affect one or both sides of the nose. It can be partial or complete. Babies with choanal atresia find it difficult to breath through the nose.

Large adenoids. Adenoids are a mass of soft tissue located where the back of the nose and back of throat meet. They are also called pharyngeal tonsils. Adenoids help the body prevent or fight infections by trapping germs. Infections cause the adenoids enlarge. The adenoids can stay enlarged even after the infection has cleared. At the beginning there may be no complaints but as the adenoids enlarge there can be mouth breathing, problems sleeping, nasal blockage, snoring, runny nose, cough, nose bleeding ,swallowing difficulties and smelly breath.

Rhinitis. Infection, irritants or allergies can cause the soft tissue lining the nasal passages to swell. This may cause a child to have a stuffy nose, runny nose ,sneezing, mucus in the throat (also called post nasal drip) and cough. Those affected by allergies may have additional problems like itchy, watery eyes; dry, itchy skin; a sore or scratchy throat. Symptoms may be constant or only last a short time.

Nasal polyps. These are growths within the nose or sinuses. They are soft and not usually painful. When they become many or large they block the nasal passages and may cause  trouble breathing through the nose, loss of smell, altered taste, a scratchy throat and a runny nose. It is not fully understand why some people develop polyps. Those with conditions like asthma, cystic fibrosis, allergy to airbone fungi and sensitivity to aspirin are more likely to develop polyps.

Pyriform aperture stenosis (PAS).This is a rare problem that a baby can be born with. It causes obstruction of the nasal passages because of an overgrowth in the bone of the upper jaw. It’s cause is not known. It can cause significant breathing and feeding difficulties.

Nasal tumours

 

What are the complications of nasal obstruction?

When a child has had blocked nose for a long time or if the blockage is severe the following complications may occur:

Obstructive sleep apnea. You may notice the child stopping to breath for several seconds due to the persistent nose blockage. This can cause serious problems.

Children with asthma can get more frequent flare-ups if they suffer frequent persistent nasal obstruction.

Sinus infections can recur more often.

Children with persistent nasal obstruction can get frequent ear infections which if not treated may increase the risk of developing hearing loss.

Impaired sleep. This can cause fatigue,daytime sleepiness,problems with concentration which impact negatively on the quality of life.

 

What tests are done to diagnose the cause of nasal obstruction?

The doctor can usually make a diagnosis depending on the answers you provide to his questions on the symptoms, and also what he finds on a general physical exam and an examination of the nose. Additional diagnostic tests may include:

Nasal endoscopy. A long flexible or rigid tube with a camera at the end is inserted into the nose. This allows the doctor to look into the nasal passages and identify swellings,growths and other problems.

Computed tomography (CT) or plain x-ray will allow the doct to point out where the problem is and asses the extent of the abnormality.

Allergy tests in the form of skin prick tests may be done if allergy is suspected to be causing or contributing to swelling within the nose;

Children diagnosed with nasal polyps may undergo additional test to rule out the presence of a condition called cystic fibrosis.

 

How is nasal obstruction treated?

Treatment will depend on the problem that the doctor has found to be causing your child’s nasal blockage and the severity of the symptoms that it is causing.

Enlarged turbinates. Your doctor may prescribe a nasal spray to help shrink the enlarged turbinates. If the swelling does not shrink surgery may be recommended. Surgical treatment may involve removing all or a part of the lower turbinate.This is called turbinectomy. It can involve using a tool to change the position of the turbinate,a procedure called turbinoplasty. Laser energy can be used to shrink the turbinate tissue

A deviated nasal septum can be treated using certain nasal decongestants or  sprays. If the medicines fail to relieve the congestion the septum can be straightened surgically in a procedure called septal reconstruction or septoplasty.

Your health care provider will remove a foreign body stuck in the nose either by sucking or pulling it out. Additional treatment may be given to treat infection if present.

Choanal atresia is treated surgically by removing the tissue that is causing the obstruction.

Enlarged adenoids are usually treated by surgical removal of the adenoids.

Rhinitis is usually treated with medicines. These include a group of medicines called antihistamines. Nasal drops or sprays are often recommended to help reduced the swelling dampen the body’s reaction to irritants. Allergens may be administered by injection (allergy shots) or as a tablet placed under the tongue. These help to reduced how the body reacts to those allergens over time. The process is called immunotherapy and may be useful for those who have severe and prolonged problems dues to allergies.

Treatment of nasal polyps usually begins with drugs that shrink them and even make them disappear. This includes steroids that are usually sprayed in the nose but may be given by mouth or through injection. Antihistamines may be used to treat allergies and antibiotics for bacterial infections. If the polyps don’t shrink or disappear surgical removal may be done to relieve problems they cause.

Children with mild cases of Pyriform aperture stenosis (PAS) will improve over time as their nasal passages become bigger as they grow. Those with severe symptoms will need surgery to remove the obstructing bone and open up the nasal passages.

What can I do at home to relieve nasal obstruction?

  • Try to avoid nasal irritants like tobacco smoke, chemical fumes, dust, pet fur and pollen.
  • Encourage regular hand washing to reduce chances of getting infections.
  • Using a humidifier at home will help moisten your nasal passages, improve the flow of mucus from your sinuses, and help prevent swelling and blockage.
  • Using salt water to rinse the nose may help improve mucus flow and remove irritants.
  • Breathing in steam can help unblock the nose.
  • Drink plenty of water to keep well hydrated.

When should I visit the doctor?

Visit the doctor when you suspect your child could be having any of the problems related to blocked nose.

See the doctor when the nose has been blocked for more than 10 days.

Seek immediate medical care if your child develops serious difficulty in breathing or if symptoms become worse.

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