Nasal Obstruction

Dr. Margaret Skinner, pediatric ENT at Johns Hopkins, performs a nasal endoscopy on a patient while his mother watches.

Dr. Margaret Skinner performs a nasal endoscopy
on her patient to examine his nose while his
mother watches.

Nasal obstruction refers to some blockage of the nose or nasal cavity and can be caused by a wide variety of problems. There are several common causes of nasal obstruction:

Inferior turbinate hypertrophy
On the inside of the nose there are normal bony structures called turbinates. They are covered by a large amount of spongy mucosa (the pink lining inside the nose). The turbinates are very susceptible to allergy and dust irritation. If they become swollen, it can be difficult to breathe through the nose.
Deviated nasal septum
The septum is the structure separating the nostrils inside the nose. A deviated nasal septum is a crooked septum. Symptoms may include difficulty breathing through the nose (especially on one side), and a runny nose. A deviated nasal septum may be caused by trauma to the nose.
Foreign bodies in the nose
Large adenoids – which block the back of the nose
Swelling of the lining of the nose from allergies
Choanal atresia
This is a congenital (present at birth) condition that is a narrowing or blockage of the nasal airway by tissue.
Pyriform aperture stenosis

Diagnosis

Your doctor will ask for a complete medical history and will perform a thorough physical examination. At Johns Hopkins, our experts perform nasal examination with lighted scopes and may use imaging, including CT scans and MRIs, when necessary. We may recommend an allergy evaluation.

Treatment

Nasal obstruction is often initially treated with medications, some of which may address underlying allergy or other reversible causes of nasal swelling. Your doctor may prescribe a nasal steroid spray to decrease inflammation of the nose and turbinates. Surgery to shrink the turbinates may be required if there is no improvement with medications. There are several new surgical techniques that can be used to shrink turbinates, including use of radiofrequency energy or a small tissue-shaving device.

Your doctor may recommend having your adenoids removed surgically if they are the cause of the nasal obstruction. Most adenoidectomies are performed on an outpatient basis.