Nasal Obstruction FAQ
What is nasal obstruction and what are its symptoms?
Nasal refers to the nose. The nasal cavity is the air passage starting at the nostril (opening of the nose) and ending at the back of the throat. Nasal Obstruction is a partial or complete blockage of one or both of these air passages. It is usually apparent right after birth when the newborn has difficulty breathing or breathing is noisy. When these babies cry, their breathing improves because the air is moving in and out of the mouth freely. Breathing problems are very problematic during feeding.
Older kids with nasal obstruction have noisy, raspy breathing, mouth breathing, snoring, and possibly a runny nose. Mouth breathing is sometimes hard to detect, but one clue can be if your child usually has their mouth open.
When is it helpful for an ear, nose, throat specialist to check for nasal obstruction?
A family doctor or pediatrician may be able to help manage some patients with nasal obstruction but an otolaryngologists, or ear, nose, throat specialist is especially qualified to evaluate and treat most of these kids. If your child is not improving during treatment by your primary care physician, depending on your insurance, you can get a referral or call directly for an appointment with an otolaryngologists.
What causes nasal obstruction?
Nasal obstruction can be caused by many different situations. Some children are born with blockages in the nasal passage, while others happen as the child gets older. Try to remember the age when the noisy breathing began, and that can help determine the cause of the obstruction. Some of the causes are noted below:
ADENOID HYPERTROPHY is another common cause of nasal obstruction in children. See this topic under common diagnoses.
Choanal atresia can be one sided (unilateral) or affect both sides (bilateral). It means that the back opening of the nose is blocked with either tissue or bone. If both sides are involved, it is usually noted shortly after birth. In this case, surgical repair is needed immediately to allow the child to breath normally. If only one side is involved, the diagnosis may be made much later in life. Symptoms include nasal discharge, stuffiness only on one side and sometimes, one-sided sinusitis. In many cases, unilateral or one-sided atresia can be repaired using telescopes through the nose.
Deviated Nasal Septum - The nasal septum separates the two nasal passages in the nose. It is made up of bone in the back and cartilage (softer tissue like the top of the ear) in the front. A child may be born with a crooked (deviated) septum, or may acquire a crooked septum through injury to the nose. If this tissue is severely twisted, it can block a nasal passage. This is commonly corrected with surgery called a SEPTOPLASTY.
Foreign Body - A common cause of nasal obstruction in the younger child is an object (foreign body) placed in the nose (such as a bead, peanut, cotton, etc.) during experimentation or play. These patients usually develop a foul smelling drainage from the nose on the side containing the object. Removal can many times be accomplished in the office. Occasionally, if the foreign body has been present a long time, a brief general anesthetic will be necessary to remove it painlessly.
Hematoma: Injury to the nose can also result in a hematoma (collection of blood) that may obstruct the nasal passage. This commonly occurs after a trauma to the nose and must be treated immediately or loss of support to the nose will result.
Nasal Polyps - these are tissues that grow and project from the sinus lining, blocking the nasal passage. Because polyps are usually the result of a chronic irritation or infection, a complete evaluation, including X-rays, is necessary to diagnose the cause and determine the extent of the problem.
RHINITIS - Inflamed or swollen nasal lining can be caused by allergies, irritants like smoke and pollution, and infection to name a few. In infants, this swelling can lead to considerable distress on the part of the child and parents. Careful evaluation of the nose will lead to the likely diagnosis. Sometimes, additional testing is necessary to confirm the cause.
Tumors: One uncommon cause of nasal obstruction in kids are benign or malignant tumors, often noticed when one side of the nose is persistently stuffy, sometimes accompanied by bleeding, drainage or swelling. A complete physical exam and x-rays usually help doctors diagnose tumors.
How would an otolaryngologists diagnose nasal obstruction?
A specialist will look at the child and the age when symptoms started, give a thorough physical exam, look into the nose using a small, flexible camera called an endoscope, and perhaps use images like those from x-rays, CT scans and MRIs to get a better look at the entire nasal passageway. X-rays, CT scans and MRIs usually take about 20 minutes and are painless.