November 19, 2021 Author : Pedro Salvador Nasal obstruction perception occurs when there is difficulty in breathing through the nose. This is a frequent complaint in otolaryngology consultations, both in adults and children. It has a negative impact on quality of life as it interferes with the various functions of the nose. The nose is the physiological airway; It has functions of defense, heating, filtering and humidifying the inspired air; It is also the organ of smell; Participates in voice resonance. In children , nasal obstruction is often associated with sleep-disorders. These children typically sleep with their mouths open, have a noisy night breathing, and sometimes parents may see apneas during sleep when the child stops breathing. Pediatric nasal obstruction has important implications for the growth of the maxillofacial skeleton as the absence of air circulation through the nose promotes vertical growth of the face. Thus, over the years, changes in palate, in the development of dentition and dental occlusion may occur. Causes of nasal obstruction Nasal obstruction can have several causes. So, it often has other associated symptoms , like: Rhinorrhea (runny nose); Itching in the nose; Feeling of pressure and heaviness on the face; Decreased sense of smell; Snoring. Nasal septum deviation Nasal septum deviation is one of the main causes of nasal obstruction. Septum misalignment r educes permeability and alters airflow , which causes congestion and facilitates the appearance of snoring during the night. As the nasal septum is a central support structure of the nose, deviations can have esthetic implications causing external deformity of the nasal pyramid. Septal deviations are often associated with chronic rhinitis and/or chronic sinusitis Rhinitis On either side of the nasal septum are the nasal turbinates, whose inflammation and hypertrophy is called rhinitis . Rinitis cause nasal obstruction, itching, sneezing and runny nose . Rhinitis often has an allergic etiology. In these circumstances, it is aggravated by exposure to allergens, for example pollen, mites, animal hair, among others. Non-allergic causes of rhinitis include infectious agents, medications, cold air, intense odors, food, among others. Sinusitis Sinusitis is inflammation of the lining of the paranasal sinuses. These are cavities located in the facial skeleton that drain into the nasal airways. The main symptoms are nasal congestion associated with pressure or heaviness on the face and a runny nose (yellowish or greenish in acute phases). Some patients have polyps in the nose and report a marked reduction in smell. The most frequent etiologies are infectious and allergic. Adenotonsillar hypertrophy Adenoid hypertrophy is an important cause of nasal obstruction in children. Adenoids are located at the back of the nose and have a defense function. When increased, they cause airflow obstruction and a typically nasal voice . They are often associated with an increase in the size of the tonsils , contributing to sleep-disorders. Recurrent adenoid infection causes congestion and runny nose, which may be associated with recurrent acute otitis media and/or hypoacusis (hearing loss). Diagnosis It is very important to correctly identify the cause of nasal obstruction. For diagnosis, the first step is to observe the nasal pyramid and nasal cavities in an otolaryngology consultation. Nasal endoscopy may be necessary. It is medical test that is carried out after decongestion and topical analgesia. A small camera runs through the nasal cavities and allows for a more accurate assessment of the nasal cavities. Some cases may require additional study by computerized tomography of the paranasal sinuses to assess the extent of the disease. Treatment of nasal obstruction Treatment consists of nose inflammation and acute infections control . Depending on the particularities of each patient, corticosteroids, antihistamines, decongestants, antibiotics, among other medications may be prescribed. Correct nasal hygiene is essential in controlling nose diseases. Some cases require surgery. Among these are some obstructive deviations of the nasal septum, rhinitis and/or chronic sinusitis. Nasal surgery has evolved and uses progressively less invasive techniques. Septoplasty, turbinoplasty and rhinoplasty Septoplasty is a procedure that allows correcting deviations of the nasal septum. In the same intervention, reduction of the nasal turbinates or turbinoplasty is often performed. This can be performed using radiofrequency, which is associated with less mucosal damage, reducing crusting and bleeding in the postoperative period, and allowing a faster healing. Septal deviation associated with nasal pyramid deformity may require the association of rhinoplasty for definitive functional and esthetic correction. Nasosinusal endoscopic surgery In some cases of chronic sinusitis, performing a endoscopic nasosinusal surgery may be necessary. This minimally invasive procedure aims to re-establish the drainage ways of the paranasal sinuses and remove polyps that interfere with a correct ventilation and that alter the olfactory function. Adenoidectomy and tonsillectomy Children with persistent nasal obstruction may need surgery, mainly when there is also nocturnal snoring. Adenoid removal or adenoidectomy is often associated with tonsil removal or tonsillectomy . The tonsils can only be reduced (partial tonsillectomy), preserving part of the tissue and tonsil function. This procedure is performed with an electric scalpel and allows for faster recovery. Meet the otorhinolaryngology clinial team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
