When it's hard to breathe

All humans experienced nasal blockage some time in their lives and some have it almost daily. In most cases, the blockage lasts for a few minutes to hours and it gets better without the patient realising it.

Some nasal blockages can be persistent and may require a detailed examination. In most cases, simple common cold or allergy rhinitis can be the cause.

Types of nasal blockages

The condition can be broadly divided into one side and both sides blockages of the nasal cavity. The causes can be almost similar except that some one-sided blockages are caused by cancers, foreign bodies (in children), antrochoanal polyps or deviated septum on one side.

Blockage on both sides can be caused by anything from narrowing of the nasal opening, allergic rhinitis, sinusitis, large internal nasal bones (hypertrophied turbinates), nasal polyps, septal deviation to nasal cancer.

Identifying the cause

The simplest method is examination of the internal nose (which can be performed by any doctor) but for details, an endoscope is fed into the nasal cavity. This is usually painless and will almost always give enough information on the cause of the blockage.

In some cases, imaging may be done, like CT Scan in order to see the details that could be missed by the endoscope particularly within the sinuses.

Nasal polyps

Polyps are out-growth of the lining of the nose which is painless. One of the main symptoms is nasal blockage. The causes of nasal polyps remain complex and are not well understood.

In most cases, they are not dangerous except that they cause nasal obstruction and loss of smell, headaches due to associated sinusitis and sometimes discomfort and pain due to the mass of the polyps.

When polyps are on one side of the nose, it is common for the doctor to do a biopsy to rule out early signs of cancer cells which is known as inverted papilloma. This condition will require a total removal of the polyps.

Treating nasal polyps

Treating nasal polyps

It is important to do a CT Scan Sinus that helps locate the polyps and anything that may be useful to the doctor.

In allergy suspecting polyps, anti allergy medication is started and in sinusitis, infection is also treated with antibiotics.

If the symptoms are troubling or there are signs of potential cancer cells, the polyps should be removed. In most cases, the polyps are removed with rotating cutting devices which causes minimal bleeding and damage to the structure of the nose.

The important part of the treatment is medications to prevent recurrence of the polyps.

Polyps growing again after surgery is common and it is difficult to predict this before surgery.

In some patients, polyps never occur again but in others, the polyps reappear just weeks after the surgery.

Nasal cancer

The nasal cavity is much bigger than the nostrils, so any cancer causing an obstruction has to be sufficiently big in size.

Advanced nasapharyngeal cancer can cause significant blockage but there may be other symptoms by then, such as neck swelling, etc.

Sometimes there are cancers that originate from the sinuses that may cause obstruction and these can be detected on endoscopy and CT Scan Sinus.

The writer is consultant ENT Surgeon at Prince Court Medical Centre.