EN4.21 | Nasal Obstruction — Summary & Reflection

KEY TAKEAWAYS

Nasal obstruction is a symptom with a broad differential ranging from benign to malignant causes. The key clinical discriminator is laterality: unilateral obstruction demands more urgent investigation to exclude structural and neoplastic causes; bilateral obstruction most commonly reflects inflammatory mucosal disease. History is paramount: the combination of age, laterality, onset pattern, associated epistaxis, and systemic features directs the differential diagnosis before examination begins. Red flags — unilateral obstruction with epistaxis in a teenage male (JNA: DO NOT BIOPSY, image first); any unilateral mass in an adult with facial swelling, diplopia, or cranial nerve involvement (malignancy: urgent endoscopy and imaging); foul-smelling unilateral discharge in a child (foreign body: removal under GA). Examination by anterior rhinoscopy and nasal endoscopy, supported by CT PNS, provides the aetiological diagnosis. Management follows the aetiology: medical first (INCS, antihistamines) for inflammatory causes; surgical for structural causes (septoplasty after age 17, turbinate reduction, FESS for polyps); adenoidectomy for adenoid hypertrophy in children; urgent ENT referral for all red-flag presentations.

REFLECT

Think about the last patient you saw with a blocked nose — either in your OPD attachment or simulated in your ENT skills session. Did you ask about laterality, duration, and associated bleeding? Did you consider the possibility of a structural cause versus a mucosal one? If you only asked about 'cold symptoms' and prescribed antihistamines, what could you have missed? The habit of systematically asking about laterality and red-flag features takes less than 60 seconds but can be the difference between a reassured patient and a missed JNA or missed nasopharyngeal malignancy. Write down the three questions you will commit to asking every patient with nasal obstruction — laterality, associated bleeding, and age — and the three scenarios that mandate urgent ENT referral before any treatment.