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Nasal Obstruction


Sometimes patients come because they feel “blocked” or “congested” – unable to breathe through the nose. This sensation may be felt on just one side of the nose, or both, or sometimes alternating back and forth between both sides. There can be many different explanations for this condition—nasal obstruction—which is why it’s important to see an ear, nose, and throat doctor if you are experiencing these symptoms.

Three common anatomical reasons for patients experiencing nasal obstruction are:

  1. deviated septum
  2. turbinate obstruction
  3. nasal valve compromise.

All three are structural problems that may hinder normal breathing through the nose.

The septum is the bone and cartilage in the middle of your nose, dividing the left from the right. The front part of the septum is what you see between your nostrils, but the septum is actually very long and extends far back into the nose. It should be situated right in the middle of the nose. If it is not in the middle, it is called “deviated septum.” This condition is very common, and it only becomes a concern when it causes nasal obstruction.

When septal deviation prevents good airflow through the nostrils, it’s important to be examined by an ear, nose, and throat doctor. Septal deviation is diagnosed by either looking up the nose with a flashlight, or by an endoscopic examination. An endoscope allows the physician to look through the entire nasal cavity, which extends far beyond what you can see through the front of the nose, with a small telescope.

Surgery is the only way to correct a septal deviation, but it is not always recommended. Sometimes it is better to instead manage the symptoms of nasal obstruction with nasal sprays to try to decrease the swelling inside the nose.

In some cases, managing the symptoms is not enough, and a “septoplasty” surgery is recommended. The goal of septoplasty is to straighten out the bone and cartilage of the nose so that the septum becomes straighter, allowing better airflow through each nostril. The surgery is minimally invasive, as it is done through the inside of the nose without any external incisions. Usually the patient recovers without bruising, swelling, or scars. It is done under general anesthesia as an outpatient surgery (meaning that you will not have to stay overnight).


Turbinate obstruction essentially means “big turbinates.” Turbinates are structures inside the nose that make up the outer edges of the nostrils, situated opposite the septum in the middle of the nose. They are composed of a layer of bone and are covered by mucosa, the lining of the nose.

The normal function of turbinates is to warm and humidify the air breathed into the nose, so that it does not irritate the lungs. The moist mucus lining of the turbinates provide water in this process. This is an important part of the respiratory system; and therefore, the turbinates cannot simply be removed without potential complications.

The mucosa of the turbinates can become inflamed for a variety of reasons, causing nasal obstruction. The inflammation can alternate on both sides at varying times of day, meaning that the nasal obstruction may come and go on each side of the nose. Most commonly, turbinate obstruction is caused by allergies, but there are other inflammatory processes and medications (specifically, the overuse or abuse of nasal sprays) that may cause turbinate obstruction.


A diagnosis of turbinate obstruction is made by an ear, nose, and throat doctor upon examination.


If the obstruction is caused by allergies, often the best treatment is to manage the inflammation with nasal steroid spray or topical antihistamines to reduce the size of the enlarged turbinates. If it is caused by abuse of medications, often discontinuing the use of that medication will alleviate turbinate obstruction symptoms.

In some cases, surgery is recommended to reduce the size of the turbinates. The goal of turbinate surgery is to shrink the turbinates to open up the nostrils and attain better airflow through the nasal passages. This surgery can be performed in an office setting and with a local anesthetic. It can also be done in conjunction with septoplasty (septal deviation surgery).

Nasal valve compromise is a common yet under-recognized cause of nasal obstruction, which may result from a patient’s unique nasal anatomy or from previous nasal surgery, trauma or aging. For patients with nasal obstruction that cannot be corrected with medical management, a septoplasty, or a turbinoplasty alone, a procedure known as a nasal valve correction (nasal valve repair) or functional rhinoplasty may help them to breathe better through their nose. This procedure is frequently performed at the same time as the septoplasty. Together, these procedures can both straighten the septum, if needed, and open up the nasal passage.

In addition to these structural reasons that cause nasal obstruction, there are medical reasons. These include:

  1. chronic rhinosinusitis
  2. nasal polyps & tumors (rarely)
  3. allergies.

Chronic sinusitis is a common condition in which the cavities around nasal passages (sinuses) become inflamed and swollen for at least 3 months, despite treatment attempts.

Also known as chronic rhinosinusitis, this condition interferes with drainage and causes mucus buildup. Breathing through your nose might be difficult. The area around your eyes and face might feel swollen, and you might have facial pain or tenderness.

Chronic sinusitis can be brought on by an infection, by growths in the sinuses (nasal polyps) or by a deviated nasal septum. The condition most commonly affects young and middle-aged adults, but it also can affect children.


At least two of the four primary signs and symptoms of chronic sinusitis must be present with confirmation of nasal inflammation for a diagnosis of the condition. They are:

  • Thick, discolored discharge from the nose or drainage down the back of the throat (postnasal drainage)
  • Nasal obstruction or congestion, causing difficulty breathing through your nose
  • Pain, tenderness and swelling around your eyes, cheeks, nose or forehead
  • Reduced sense of smell and taste in adults or cough in children

Other signs and symptoms can include:

  • Ear pain
  • Aching in your upper jaw and teeth
  • Cough that might worsen at night
  • Sore throat
  • Bad breath (halitosis)
  • Fatigue or irritability
  • Nausea

Chronic sinusitis and acute sinusitis have similar signs and symptoms, but acute sinusitis is a temporary infection of the sinuses often associated with a cold. The signs and symptoms of chronic sinusitis last longer and often cause more fatigue. Fever isn’t a common sign of chronic sinusitis, but you might have one with acute sinusitis.

When to see a doctor

You may have several episodes of acute sinusitis, lasting less than four weeks, before developing chronic sinusitis. You may be referred to an allergist or an ear, nose and throat specialist for evaluation and treatment.

Schedule an appointment with Dr Economou:

  • You’ve had sinusitis a number of times, and the condition doesn’t respond to treatment
  • You have sinusitis symptoms that last more than seven days
  • Your symptoms don’t improve after you see your doctor

See Dr Economou immediately if you have any of the following, which could indicate a serious infection:

  • High fever
  • Swelling or redness around your eyes
  • Severe headache
  • Confusion
  • Double vision or other vision changes
  • Stiff neck


Common causes of chronic sinusitis include:

  • Nasal polyps.These tissue growths can block the nasal passages or sinuses.
  • Deviated nasal septum.A crooked septum — the wall between the nostrils — may restrict or block sinus passages.
  • Other medical conditions.The complications of cystic fibrosis, gastroesophageal reflux, or HIV and other immune system-related diseases can result in nasal blockage.
  • Respiratory tract infections.Infections in your respiratory tract — most commonly colds — can inflame and thicken your sinus membranes and block mucus drainage. These infections can be viral, bacterial or fungal.
  • Allergies such as hay fever.Inflammation that occurs with allergies can block your sinuses.

High risk patients

You’re at increased risk of getting chronic or recurrent sinusitis if you have:

  • A nasal passage abnormality,such as a deviated nasal septum or nasal polyps
  • Asthma,which is highly connected to chronic sinusitis
  • Aspirin sensitivitythat causes respiratory symptoms
  • An immune system disorder,such as HIV/AIDS or cystic fibrosis
  • Hay fever or another allergic conditionthat affects your sinuses
  • Regular exposure to pollutants such as cigarette smoke


Chronic sinusitis complications include:

  • This infection causes inflammation of the membranes and fluid surrounding your brain and spinal cord.
  • Other infections.Uncommonly, infection can spread to the bones (osteomyelitis) or skin (cellulitis).
  • Partial or complete loss of sense of smell.Nasal obstruction and inflammation of the nerve for smell (olfactory nerve) can cause temporary or permanent loss of smell.
  • Vision problems.If infection spreads to your eye socket, it can cause reduced vision or even blindness that can be permanent.


The goal of treating chronic sinusitis is to:

  • Reduce sinus inflammation
  • Keep your nasal passages draining
  • Eliminate the underlying cause
  • Reduce the number of sinusitis flare-ups

There are two major Treatment categories of chronic Rhinosinusitis to relieve symptoms

These treatments include:



Corticosteroids & Saline solutions

  • Saline nasal irrigation,with nasal sprays or solutions, reduces drainage and rinses away irritants and allergies.
  • Nasal corticosteroids.These nasal sprays help prevent and treat inflammation. Examples include fluticasone, triamcinolone, budesonide, mometasone and beclomethasone.

If the sprays aren’t effective enough, your doctor might recommend rinsing with a solution of saline mixed with drops of budesonide or using a nasal mist of the solution.

  • Oral or injected corticosteroids.These medications are used to relieve inflammation from severe sinusitis, especially if you also have nasal polyps. Oral corticosteroids can cause serious side effects when used long term, so they’re used only to treat severe symptoms.


Antibiotics are sometimes necessary for sinusitis if you have a bacterial infection. If an underlying infection cannot ruled out, your doctor may recommend an antibiotic, sometimes with other medications.


If allergies are contributing to your sinusitis, allergy shots (immunotherapy) that help reduce the body’s reaction to specific allergens might improve the condition.

Aspirin desensitization treatment

if you have reactions to aspirin that cause sinusitis. Under medical supervision, you’re gradually given larger doses of aspirin to increase your tolerance.




Endoscopic sinus surgery

In cases resistant to treatment or medication, endoscopic sinus surgery might be an option. For this procedure, the doctor uses a thin, flexible tube with an attached light (endoscope) to explore your sinus passages.

Depending on the source of obstruction, the doctor might use various instruments to remove tissue or shave away a polyp that’s causing nasal blockage. Enlarging a narrow sinus opening also may be an option to promote drainage.

Nasal polyps are soft, painless, benign growths on the lining of your nasal passages or sinuses. They hang down like teardrops or grapes. They result from chronic inflammation due to asthma, recurring infection, allergies, drug sensitivity or certain immune disorders. However, in rare cases nasal polyps are associated with a benign or malignant tumor.

Small nasal polyps may not cause symptoms. Larger growths or groups of nasal polyps can block your nasal passages or lead to breathing problems, a lost sense of smell and frequent infections.

Nasal polyps can affect anyone, but they’re more common in adults. Medications can often shrink or eliminate nasal polyps, but surgery is sometimes needed to remove them. Even after successful treatment, nasal polyps often return.


Nasal polyps are associated with inflammation of the lining of your nasal passages and sinuses that lasts more than 12 weeks (chronic rhinosinusitis, also known as chronic sinusitis). However, it’s possible — and even somewhat more likely — to have chronic sinusitis without nasal polyps.

Nasal polyps themselves are soft and lack sensation, so if they’re small you may not be aware you have them. Multiple growths or a large polyp may block your nasal passages and sinuses.

Common signs and symptoms of chronic sinusitis with nasal polyps include:

  • A runny nose
  • Persistent stuffiness
  • Postnasal drip
  • Decreased or absent sense of smell
  • Loss of sense of taste
  • Facial pain or headache
  • Pain in your upper teeth
  • A sense of pressure over your forehead and face
  • Snoring
  • Nasal bleeding often occurs in cases of benign or cancerous tumors.


Scientists don’t yet fully understand what causes nasal polyps. It’s not clear why some people develop chronic inflammation or why ongoing inflammation triggers polyp formation in some people and not in others. The inflammation occurs in the fluid-producing lining (mucous membrane) of your nose and sinuses. There’s some evidence that people who develop polyps have a different immune system response and different chemical markers in their mucous membranes than do those who don’t develop polyps.

Nasal polyps can form at any age, but they’re most common in young and middle-aged adults. Nasal polyps may form anywhere in your sinuses or nasal passages, but they appear most often in an area where sinuses near your eyes, nose and cheekbones all drain through winding passages into your nose (osteo-meatal complex).

Risk factors

Any condition that triggers chronic inflammation in your nasal passages or sinuses, such as infections or allergies, may increase your risk of developing nasal polyps. Conditions often associated with nasal polyps include:

  • Asthma,a disease that causes overall airway inflammation and constriction
  • Aspirin sensitivitymay cause some people to be more likely to develop nasal polyps
  • Allergic fungal sinusitis,an allergy to airborne fungi
  • Cystic fibrosis,a genetic disorder that results in the production and secretion of abnormally thick, sticky fluids, including thick mucus from nasal and sinus membranes
  • Churg-Strauss syndrome,a rare disease that causes the inflammation of blood vessels

Your family history also may play a role. There’s some evidence that certain genetic variations associated with immune system function make you more likely to develop nasal polyps.


Nasal polyps can cause complications because they block normal airflow and fluid drainage, and also because of the chronic inflammation underlying their development. Potential complications include:

  • Obstructive sleep apnea.In this potentially serious condition, you stop and start breathing frequently during sleep.
  • Asthma flare-ups.Chronic rhinosinusitis can aggravate asthma.
  • Sinus infections.Nasal polyps can make you more susceptible to sinus infections that recur often or become chronic.