Presented by Ms Romana Kuchai MRCS DLO MD FRCS (ORL-HNS) Consultant ENT Surgeon

1. is pleased to welcome you to The Blocked Nose: A Walk through its Management Presented by Ms Romana KuchaiMRCS DLO MD FRCS (ORL-HNS) Consultant ENT Surgeon

2. Causes • What is a nasal obstruction? Nasal obstruction is the sensation of reduced air flow either through one nostril (unilateral) or both nostrils (bilateral).

4. There are four main sub-divisions: • Mucosal swelling • Septal deviation • Collapse of the nasal valves • Nasopharyngeal obstruction

5. Mucosal Swelling The mucosa is the thin moist lining that covers the bone and cartilage inside the nose

7. a) Autonomic Rhinitis • Clear mucus production is the primary problem with less nasal obstruction. This is due to over-activity of the glands in the nose. It is not common and usually occurs in the over 60s. • Non- allergic and non- inflammatory • Causes- environment, air-borne irritants, emotions, barometric

8. b) Rhinitis medicamentosa Overuse of some decongestant nasal sprays (Otrivine, Sinex). These can help decongest the nose for a few hours during an upper respiratory infection but should not be taken for more than a few days as they damage the lining of the nose.

10. c) Chronic infection • This is not common. • It is associated with a discoloured production of green mucus through the day. • Chronic rhinosinusitis must be considered • ENT Rigid Nasendoscopy- rhinitis, pus in nasal airway and/or middle meatus

11. d) Idiopathic rhinitis • Where neither allergy nor infection can be found yet the lining of the nose is swollen. • A range of rare conditions can affect the lining of the nose. These often cause significant crusting, spotting of blood and nasal obstruction. • Where crusting persists referral for a further opinion with ENT essential

12. Other types of rhinitis • Atrophic Rhinitis • Polypoid Rhinitis

14. Septal Deviation • The septum is a thin piece of bone and cartilage separating the left and the right side of the nasal cavity. • In some people the septum is bent or deviated over to one side and this blocks the air passage of the nose.

16. Nasal obstruction is the predominant symptom, usually on one side. However, if other symptoms are present other disease processes must be excluded • Management depends on the severity of nasal obstruction. Surgery to correct the deformity can be undertaken if the nose is blocked or unsightly.

17. Septal deviation may be associated with a visibly deformed nose and a history of nasal trauma although it is not necessary as the cartilage may bend and deform as the nose as it grows.

18. Collapse of the nasal valves • Normally on breathing in through the nostrils there is a small amount of collapse of the nostrils. Often this collapse stops if the mucosal swelling (as mentioned above) is treated. • Occasionally the problem is primarily due to a ‘floppy' valve or side wall of the nose collapsing. Treatment using external nasal splints can sometimes be help at night. Surgery in this area is not straightforward

20. Nasopharyngeal obstruction • Adenoids are the most common cause of nasal obstruction in children reaching maximum size between the age of three and five and then reduce in size often by the age of seven or eight and can hardly be seen by the late teens.

22. Snoring alone is not an indication for adenoid removal but if the child also stops breathing while asleep (apnoea - stops breathing for more than 10 seconds regularly without a cold) then adenoidectomy and tonsillectomy may be helpful.

23. Be aware • In children with a blocked nose on one side and a one sided nasal discharge, a foreign body may be in the nose

24. Nasal polyps are rare in children and further tests should be done

25. Nasal obstruction of one side of the nose in adults, with or without bleeding, needs to be examined carefully by an ear nose and throat surgeon

26. Avoid the long-term use of nasal medication purchased over the counter in chemists unless specifically advised

27. Deviated nasal septum- a common cause of nasal blockage – can be treated with the septoplasty operation.

28. When to refer to ENT ? • Symptoms refractory to medical therapy for 3 months i.e nasal decongestants • Associated symptoms- e.g snoring, anosmia, post nasal drip, dysphonia , facial pain • Visible polypoid disease • Unilateral polypoid disease • Epistaxis associated with obstruction

29. We look forward to seeing you at one of our future workshops. Ms Romana Kuchai sees Patients here at TMCK on Wednesday and Friday afternoons. Appointments can be made by telephoning Reception on 0207 244 4200