Nasal Obstruction

What is nasal obstruction?
Nasal obstruction is when the nasal passages are blocked, or there is difficulty breathing from the nose.  This may be from rhinorrhea (runny nose), or it can be from other sources.
What causes it?
The nasal cavity can be blocked by several causes including:

• Colds and flus: Mucus from illnesses can fill the nasal cavity and cause temporary nasal obstruction.
• Infections of the sinuses and or adenoids: The sinuses, or cavities of the face that drain into the nose, can fill with infected mucus resulting in sinusitis. The adenoids, tissue found in the back of the nose (nasopharynx), in children can also get infected and result in a similar production of infected mucus. 
• Allergic rhinitis:  Mucus can result from allergies, or a nasal reaction to allergens such as pollen or pet dander.  
• Non-allergic rhinitis: Mucus can result from a nasal reaction to an irritant like smoke or pollution.
• Large/swollen turbinates:  The bones along the inside the nose can be large or swell due to allergies or infections and result in nasal obstruction.
• Large adenoids: When the tissue in the back of the nose in children is enlarged.
• Nasal polyps: Grape-like growths in the lining of the nose.
• Foreign body insertion: More often in younger children, the cause of obstruction may be the placement of an object in the nose, such as a peanut or a bead, causing obstruction, and foul smelling mucus drainage.
• Nasal cysts or tumors: Rarely, obstruction is from benign or malignant tumors, or cysts, more commonly when the symptoms affect only one side of the nose.
• Choanal atresia or pyriform aperture stenosis: Choanal atresia describes the situation when the back of the nose (nasopharynx) is closed off with bone and/or tissue at birth. When it is present on both sides (bilateral), it is often found right after birth. However, if it is only present on one side, it is often not discovered until later in life.  Pyriform aperture stenosis describes when the bony nasal opening is narrow, obstructing the nose.
• Deviated nasal septum: The right and left sides of the nose are separated by a wall made of bone and cartilage called the nasal septum. At times, the septum can lean more to one side, causing obstruction on that side. This deformity can be present at birth or a result of trauma to the nose later in life.

Why is it a concern?
Often, nasal obstruction from mucus, or a runny nose, is self-limited and goes away on its own. When it persists, nasal obstruction can be the symptom of other causes such as those listed above and is something that needs to be managed.
How do we evaluate it?
When nasal obstruction is due to allergic rhinitis, your child may be asked to see an allergist by your primary doctor. Your child may also be asked to see an Ear, Nose and Throat specialist (Otolaryngologist). The specialist will get a complete history and examine the front of the nose, and just along the inside.  A speculum may be used for a better view of the nose, and in some cases, a flexible fiberoptic camera may be used to evaluate the entire nasal cavity to the very back of the nose (nasopharynx). This can be done in clinic without the need for general anesthesia.
How is it treated?
Once the source of the obstruction is found, treatment can include watchful waiting, washing the nose with nasal rinses, medications taken by mouth or sprayed into the nose, or surgery.
What are the long-term effects?
Depending on the source of nasal obstruction, the long-term effects can vary. Newborn infants must breath from the nose to coordinate breathing with nursing and feeding.  Nasal irritation and nasal obstruction can impact a child’s quality of life if it is longstanding. An obstructed nasal passageway can affect sleep quality. Breathing from the nose is also important for facial development in childhood. Rarely, acute infections of the sinuses can lead to more serious infections if left untreated. Nasal obstruction and rhinorrhea (runny nose) may impact the health of the ears and can affect hearing as the drainage pathway for the middle ear is through the back of the nose (nasopharynx).

Learn more about Pediatric Otolaryngology or call us at (650) 724-4800 for more information.