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, you can get a referral or call directly for an appointment with an otorhinolaryngologist.

What causes a 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.
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 breathe 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 a 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 anaesthetic 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 CT scan, 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.
Tumors – One uncommon cause of nasal obstruction 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 CT scan 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.

Allergic rhinitis is an allergy reaction affecting the lining of the nose that may be due to any one of several million different pollens, microscopic animals such as the house dust mite, skin scale or hair particles from animals.

When the sensitive moist membranes that line the nose first come into contact with the sensitizing particle ( an allergen), there is no reaction, but the body’s immune system is primed to react to the next invasion. On the second exposure the large immunoglobulin proteins, which act to defend the body against invasion by any foreign matter, react violently. They cluster around mast cells that rupture and release histamine into the nasal tissues. This causes the tissue to become inflamed. After a few hours or days, the body destroys the histamine released, and the tissues return to normal

When the sensitive moist membranes that line the nose first come into contact with the sensitizing particle ( an allergen), there is no reaction, but the body’s immune system is primed to react to the next invasion. On the second exposure the large immunoglobulin proteins, which act to defend the body against invasion by any foreign matter, react violently. They cluster around mast cells that rupture and release histamine into the nasal tissues. This causes the tissue to become inflamed. After a few hours or days, the body destroys the histamine released, and the tissues return to normal

Antihistamine tablets or nose sprays are used to counteract the histamine released into the tissue and ease the symptoms but some types of antihistamines may cause drowsiness. Steroid nasal sprays or anti-allergy sprays used regularly prevent the nose from reacting to allergens. Allergy shots (immunotherapy) are occasionally recommended if the allergen cannot be avoided and if symptoms are hard to control. Blood or skin tests are performed to determine which allergens cause the allergic symptoms. If a cause can be found, regular injections of the allergen are given in increasing doses (each dose is slightly larger than the previous dose) that may help the body adjust to the antigen. The last resort is surgery in which the anatomical abnormalities are corrected to improve the functions of the nose.

Prevention

Symptoms can sometimes be prevented by avoiding known allergens. During the pollen season, people with hay fever should remain indoors in an air-conditioned atmosphere whenever possible:

• Most trees produce pollen in the spring.
• Grasses usually produce pollen during the late spring and summer.
• Ragweed and other late-blooming plants produce pollen during late summer and early autumn.

The purpose of the nose is to warm and humidify the air that we breathe in. The nose is lined with many blood vessels that lie close to the surface and is situated in a vulnerable position as it protrudes on the face. As a result, trauma to the face can cause nasal injury and bleeding. Once a vessel starts to bleed, the bleeding tends to recur since the clot or scab is easily dislodged. Nosebleeds, called epistaxis, can be messy and even scary, but often look worse than they are. Nosebleeds can occur spontaneously when the nasal membranes dry out and crack. This is common in dry climates, or during the winter months when the air is dry and warm from household heaters.

People are more susceptible to a bloody nose if they are taking medications which prevent normal blood clotting like warfarin, aspirin, or any anti-inflammatory medication. In this situation, even a minor trauma could result in significant bleeding. The incidence of nosebleeds is higher during the colder winter months when upper respiratory infection is more frequent, and the temperature and humidity fluctuate more dramatically.

Common causes of nosebleeds:

• Dry, heated, indoor air, which dries out the nasal membranes and causes them to become cracked or crusted and bleed when rubbed or picked or when blowing the nose (more common in winter months)
• Cold (upper respiratory infections) and sinusitis, especially episodes that cause repeated sneezing, coughing, and nose blowing
• Vigorous nose blowing or nose picking
• The insertion of a foreign object into the nose
• Injury to the nose and/or face
• Use of drugs that thin the blood (aspirin, non-steroidal anti-inflammatory medications, warfarin, and others)
• High blood pressure
• Chemical irritants (e.g., cocaine, industrial chemicals, others)
• Deviated septum (an abnormal shape of the structure that separates the two sides of the nose)
• Tumors or inherited bleeding disorders (rare)

How are nosebleeds stopped?

• Sit down and lean your body and your head slightly forward.
• Breathe through your mouth.
• Use a tissue or damp washcloth to catch the blood.
• Use your thumb and index finger to pinch together the soft part of your nose. Make sure to pinch the soft part of the nose against the hard bony ridge that forms the bridge of the nose. Squeezing at or above the bony part of the put pressure where it can help stop bleeding.
• Keep pinching your nose continuously for at least 10 minutes (timed by a clock) before checking if the bleeding has stopped. If your nose is still bleeding, continue squeezing the nose for another 10 minutes.
• Once the bleeding stops, DO NOT bend over; strain and/or lift anything heavy and DO NOT blow, rub, or pick your nose for several days.

Under what conditions should I seek physician or emergency care?

• You cannot stop the bleeding after more than 15 to 20 minutes of applying direct pressure.
• You experience repeated episodes of bleeding.
• The bleeding is rapid or the blood loss is large.
• The bleeding was caused by an injury, such as a fall or other blow to the nose or face.
• You feel weak or faint.
• The blood goes down the back of your throat rather than out front through the nose even though you are sitting down with the body and head leaning slightly forward. (This may indicate the rarer, but more serious, “posterior nosebleed,” which almost always requires a physician’s care. This condition occurs more frequently in older people and individuals with high blood pressure).
• You get a nosebleed that seems to have occurred with the start of a new medication.
• You get nosebleeds accompanied by unusual bruising all over your body. (This combination may indicate a more serious condition and will need to be investigated by your doctor.)

How might an emergency room doctor treat the nosebleed?

• The doctor will ask you questions about your nosebleed and examine your nose to try to determine the source of the nosebleed. He or she will use a small speculum to hold the nose open and can use various light sources or an endoscope (lighted scope) to see inside your nasal passages. Your doctor may use topical medications to anesthetize (numb) the lining of the nose and to constrict blood vessels. The doctor is also likely to remove clots and crusts from inside your nose. This can be unpleasant but need not be painful. Occasionally x-rays or blood tests are ordered.
• Treatments, depending on the cause, could include:
• Nasal packing – the placement of strips of gauze into the nasal cavity to create pressure on the bleeding site. Alternately, other materials that promote clotting may be used. Nasal packs are used when less conservative measures fail. These packs are frequently placed in both sides of the nose. The packs are usually made of a material called “Merocel” which is a compressed sponge-like material used to help compress the area of the nose that is bleeding. The doctor usually does not remove them for several days (two to three days). This requires a follow-up appointment.
• Cauterization – the application of a chemical substance (silver nitrate) or heat energy (electrocautery) to seal the bleeding blood vessel.
• Medication adjustments – reducing or stopping the amount of blood thinning medications can be helpful. In addition, medications for controlling blood pressure may be necessary.
• Foreign body removal
• Repair of nasal fracture
• Correction of a deviated septum

How do you prevent the nose from bleeding again?

• Go home and rest with head elevated at 30 to 45 degrees.
• Do not blow your nose or put anything into it. If you have to sneeze, open your mouth so that the air will escape out the mouth and not through the nose.
• Do not strain during bowel movements. Use a stool softener.
• Do not strain or bend down to lift anything heavy.
• Try to keep your head higher than the level of your heart.
• Do not smoke.
• Stay on a soft, cool diet. No hot liquids for at least 24 hours.
• Do not take any medications that will thin the blood (aspirin, ibuprofen, clopidogrel or warfarin). If these have been prescribed by your physician, you need to contact them regarding stopping these medications.
• Your doctor may recommend some form of lubricating ointment for the inside of the nose.
• If re-bleeding occurs, try to clear the nose of clots by sniffing in forcefully. Control high blood pressure. Repeat the steps above on how to stop the common nose bleed. If bleeding persists, call the doctor and/or visit the emergency room.

What precautions can you take to prevent nose bleeding?

The most common cause of a nose bleeds is drying of the nasal membranes. If you are prone to recurrent nosebleeds, it is often helpful to try lubricating the nose with an ointment of some type.

Sinusitis is a bacterial or viral infection of the moist membrane that lines the air-filled sinuses in the face. The sinuses are aerated cavities in the bones of the face that develop from the nasal cavity and maintain communication with it. They lie in the skull bone below, above, between and behind the eyes and are connected together and to the nose by small holes and drainage tubes.

Some people secrete excess amounts of fluid in the sinuses because of hay fever, smoking or irritating fumes, while others may have drainage holes and tubes that are too small to cope with the secretions produced. An attack begins with the inflammation of the nasal mucous membrane. This causes an obstruction of the opening of the sinus leading eventually to secretions accumulating in the sinus with associated pain and swelling. The secretions get infected exacerbating the situation. If bacteria or viruses infect the sinus lining or secretions, sinusitis results.

Sinusitis causes thick and pus-like phlegm to drain from the nose and down the throat, the face is very painful and tender and there is fever, headache and tiredness. The infection may spread to the middle ear. The risks of sinusitis is that it can become chronic or lead to complications such as orbital cellulitis, meningitis and brain abscess, which can even be fatal. An X-ray of the para nasal sinuses is often the first test done. Haziness or opacities in the region of the infected sinus is often seen. A CT Scan is usually required for confirmation.

Swabs may be taken from the back of the nose so that the type of bacteria causing the infection can be determined and the correct treatment selected. The treatment may be either medical or surgical. The initial treatment involves administration of appropriate antibiotics along with an analgesic and an anti-histaminic. Steam inhalation and nasal spray could also provide relief and may be used to relieve the congestion. Avoiding nasal irritants and allergens may help. Irrigation and drainage of the affected sinus is sometimes done. In patients who suffer from repeated attacks, minimally invasive surgical procedures are done to drain the sinuses more effectively.

The prognosis is often quite good and depends upon the sinuses involved and the duration of the infection. Most patients who have acute sinusitis of a short duration generally recover with appropriate early therapy. However chronic sinusitis can be quite a problem and even after drainage patients may be symptomatic. Some patients may require radical surgical techniques for cure.

Post nasal drip is an unscientific term that refers to the sensation of thick phlegm in the throat, which can become infected. It is annoying because normally the throat is moistened by the nasal secretions and throat mucous glands. When the amount of liquid secreted by the nose and sinus is reduced, and the cilia of the nose and sinus slow down, the fluid thickens and you become aware of its presence. Since the thick phlegm is unpleasant and often infected because it is “just laying there” and not moving, our bodies naturally try to get rid of it, to the annoyance of our partners. Whether caused by pollution, chemical exposure, or severe infection, the treatment requires that the cilia mucous system be brought back to normal. Excess mucus settles and irritates the nasal and throat lining causing the following:
-Sore throat
-Bad breath(halitosis)
-Cough

What are the causes of Post Nasal Drip?

• Inhaled Irritants- This causes a swelling of the nasal and sinus linings which is very common where there is a lot of smog, dust and smoke.
• Food Allergies – These cause mucus to thicken and cause bad drainage.
• Illnesses – Colds, Flu, Bronchitis, Ear Infections and Tonsillitis are the main causes of PND and the production of excess mucus.

What are the symptoms of Post-Nasal Drip (PND)?

• Clearing your throat all the time – This is the most common symptom of PND. The mucus drains from your sinuses and collect at the top of the throat area.
• Constantly swallowing – This is due to the excess mucus caused by PND

Effective Natural Treatment

Moisturize and clean your nose frequently, right away when you are exposed to fumes, smoke, or dust. A good sinus moisturizer can be used as often as desired. Whatever helps to move the cilia helps post nasal drip. Pulsatile Nasal Irrigation performed daily for 2 weeks is often sufficient because the pulsation encourages good ciliary movement. Stagnant mucus is also removed along with bacteria. Often the key is to simply drink enough water to liquefy the secretions. Ice drinks slow the cilia, and so do most antihistamines. Sometimes patients are taking a large number of various medications and these combine to make the nose dry. Here, pulsatile irrigation is probably the best treatment.