Nasal obstruction
Nasal obstruction: Excerpt from Signs & Symptoms: A 2-in-1 Reference for Nurses
Nasal obstruction may result from an allergic, inflammatory, neoplastic, endocrine, or metabolic disorder; a structural abnormality; a traumatic injury; or a mechanical obstruction (foreign objects). It may cause discomfort, alter a person’s sense of taste and smell, and cause voice changes. Although a common and typically benign symptom, nasal obstruction may herald certain life-threatening disorders, such as a basilar skull fracture or malignant tumor.
History
Begin the history by asking the patient about the duration and frequency of the obstruction. Did it begin suddenly or gradually? Is it intermittent or persistent? Unilateral or bilateral? Inquire about the presence and character of drainage. Is it watery, purulent, or bloody? Does the patient have nasal or sinus pain or headaches? Ask about recent travel, the use of drugs or alcohol, and previous trauma or surgery.
Physical assessment
Examine the patient’s nose; assess airflow and the condition of the turbinates and nasal septum. Evaluate the orbits for any evidence of dystopia, decreased vision, excess tearing, or abnormal appearance of the eye. Palpate over the frontal and maxillary sinuses for tenderness. Examine the ears for signs of middle ear effusions. Inspect the oral cavity, pharynx, nasopharynx, and larynx to detect inflammation, ulceration, excessive mucosal dryness, and neurologic deficits. Last, palpate the neck for adenopathy.
Medical causes
Basilar skull fracture
A tear in the dura can lead to cerebrospinal rhinorrhea, which increases when the patient lowers his head. Associated findings may include epistaxis, otorrhea, and a bulging tympanic membrane from blood or fluid. A fracture may also cause headache, facial paralysis, nausea, vomiting, impaired eye movement, ocular deviation, vision and hearing loss, depressed level of consciousness, Battle’s sign, and raccoon eyes.
Common cold
Onset of the common cold is typified by a watery discharge along with sneezing and nasal obstruction. Edema of the nasal mucosa may lead to sinus pain and infection as well as loss of smell and taste. Related findings include sore throat, malaise, myalgia, arthralgia, and mild headache.
Hypothyroidism
An underactive thyroid gland may lead to a generalized hypoactive state. This can lead to vascular dilation in the nasal mucosa, resulting in nasal obstruction. Associated findings include fatigue, weight gain despite anorexia, cold intolerance, facial edema, impaired memory, brittle hair, thick skin and tongue, bradycardia, and a hoarse voice.
Nasal deformities
Deviation of the nasal septum may cause unilateral or bilateral nasal obstruction, snoring, and postnasal drip. Perforation of the nasal septum may result in a sensation of nasal congestion due to altered air flow.
Nasal fracture
Nasal obstruction develops because of trauma that results in nasal mucosal swelling, epistaxis, abscess, or a septal deviation. Periorbital ecchymoses and edema, nasal deformity and pain, and crepitation of the nasal bones may also occur.
Nasal polyps
The most common signs and symptoms of nasal polyps are nasal obstruction, anosmia, and clear, watery drainage. The patient may have a history of allergies, chronic sinusitis, trauma, cystic fibrosis, or asthma. Translucent, pear-shaped polyps that are unilateral or bilateral occur.
Nasal tumors
Benign and malignant nasal tumors may cause unilateral or bilateral nasal obstruction, rhinorrhea, epistaxis, pain, foul discharge, and cheek swelling. Most of these tumors are benign papillomas and minor salivary gland tumors; malignant ones are rare. Kaposi’s sarcoma of the nose may occur in acquired immunodeficiency syndrome.
Nasopharyngeal tumors
Benign and malignant tumors of the nasopharynx may cause nasal obstruction, rhinorrhea, epistaxis, otitis media, and nasal speech. Tumors usually reach a considerable size before symptoms develop. Cancer of the nasopharynx is the most common malignancy of the nasopharynx and may present first with a neck mass or conductive hearing loss.
Pregnancy
High levels of estrogen during pregnancy may cause vascular engorgement of the nasal mucosa, resulting in nasal obstruction. Associated findings include clear or blood-tinged drainage, sneezing, and edematous and bluish turbinates.
Rhinitis
Allergic rhinitis produces intermittent watery discharge and nasal obstruction. Common signs and symptoms include sneezing, increased lacrimation, decreased sense of smell, postnasal drip, and itching of the eyes, nose, or ears. The mucosa is edematous and pale.
Vasomotor rhinitis produces a profuse watery nasal discharge in addition to nasal obstruction. Sneezing, postnasal drip, and swollen turbinates occur as well.
With atrophic rhinitis, nasal obstruction is chronic and continuous. Associated findings include intermittent, purulent drainage, foul drainage odor, and nasal crusts that bleed on removal. The mucosa is pale pink and shiny.
Sinusitis
With acute sinusitis, the usual findings are marked nasal obstruction along with thick, purulent drainage and severe pain over the involved sinuses. Fever, inflamed nasal mucosa with purulent mucus, and facial tenderness and pressure occur.
With chronic sinusitis, nasal obstruction can be persistent or recurrent. Thick, intermittently purulent rhinorrhea and low-grade discomfort over the involved sinuses are also seen.
Chronic fungal sinusitis is clinically similar to chronic bacterial sinusitis. However, in immunocompromised patients the disease may rapidly progress to proptosis, blindness, and death.
Other causes
Drugs
Topical nasal vasoconstrictors may cause rebound rhinorrhea and nasal obstruction if used longer than 5 days. Antihypertensives may cause nasal congestion as well.
Surgery
Nasal obstruction may occur after sinus or cranial surgery or even after rhinoplasty.
Special considerations
Prepare the patient for X-rays or computed tomography scans of the nose, sinuses, or skull. Promote fluid intake to thin secretions as needed. Give an antihistamine, a decongestant, an analgesic, or an antipyretic.
Pediatric pointers
Acute nasal obstruction in children commonly results from the common cold. In infants and children, especially between ages 3 and 6, chronic nasal obstruction typically results from large adenoids. In neonates, choanal atresia is the most common congenital cause of nasal obstruction and can be unilateral or bilateral. Cystic fibrosis may cause nasal polyps in children, resulting in nasal obstruction. However, if the child has unilateral nasal obstruction and rhinorrhea, you should assume that a foreign body is in the nose until proven otherwise.
Patient counseling
Tell the patient not to use over-the-counter nasal vasoconstrictor sprays for more than 5 days. If the patient requires nasal surgery, advise him to limit such activities, as bending at the waist, exercising vigorously, and sneezing with his mouth open.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
More About Nose conditions
More Medical Textbooks Online about Nose conditions
Review other book chapters online related to Nose conditions:
Medical Books Excerpts
- Nasal flaring
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Nosebleed
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page:
Nasal Discharge (The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
