Intermittent nasal obstruction

Introduction Nasal obstruction is one of the common symptoms of otolaryngology. The most common causes include rhinitis, nasal septum deviation, nasal polyps, and sinusitis. The nasal obstruction of simple chronic rhinitis is intermittent and alternating, when the time is light and heavy, and the lower nasal congestion is heavier when lying on the side. In theory, nasal congestion can be solved by different treatment methods. Nasal congestion can cause the patient to breathe without the nose, and the patient must breathe, so that it is very troublesome to have some simple daily activities such as eating, drinking, talking or sleeping. Then the nasal congestion also makes the patient unable to concentrate during the day and feels that the patient does not breathe air. Some patients may develop symptoms of anxiety or headache.

Cause

Nasal malformation: children due to congenital or acquired fatigue, causing narrow nasal obstruction of the nasal cavity, partial or complete occlusion of the nose and nasopharynx affecting the natural ventilation of the nose will occur nasal congenital congenital often due to abnormal development of the normal embryonic period, Such as congenital anterior and posterior nostril atresia, etc.; acquired are mostly sequelae of trauma, fatigue, surgery and specific infection, such as scald, tuberculous ulcer, syphilis, granuloma, surgical scar, etc.; sometimes nasal malignant tumor after radiotherapy Scar contracture can also cause nasal obstruction.

Proliferative hypertrophy: Proliferative body, also known as pharyngeal tonsil or adenoid, is located in the lymphatic tissue at the top of the nasopharynx. It is abundant in childhood. When it hypertrophy, it often blocks the posterior nares and nasal obstruction. Various rhinitis and sinusitis (including allergic rhinitis and sinusitis) have nasal mucosal congestion or allergic edema, sometimes accompanied by nasal swelling, increased secretions during inflammation, narrowing the nasal cavity, affecting the natural ventilation of the nose. Nasal congestion; while atrophic rhinitis, although large in the nasal cavity, can also affect nasal ventilation due to dryness.

Foreign body in the nasal cavity: Foreign bodies occupy the intranasal space and stimulate secretion to cause nasal congestion.

Nasal polyps or polypoid changes: Nasal polyps or polypoid changes narrow the nasal passages, and patients are often accompanied by chronic rhinitis or allergic rhinitis, which increases the degree of nasal congestion.

Deviation of the nasal septum: In severe cases, the nasal septum is narrowed toward one side of the airway and the compensatory hypertrophy in the contralateral nasal cavity is impeding ventilation. In addition to mechanical obstruction caused by occupying the intranasal ventilation space, the tumor in the nasal cavity or sinus also compresses the normal anatomical structure of the nose to cause ulceration and necrosis to stimulate the secretion of the nasal mucosa, so that the nasal obstruction is progressively aggravated.

Postural factors: When lying on the side, due to the gravity of the blood, the nasal side lying underneath is blocked by the swelling of the nasal turbinate.

Systemic factors: endocrine disorders: such as mucosal edema in patients with hypothyroidism, systemic vasomotor disorders during pregnancy and certain effects of drugs and drugs can cause nasal obstruction.

Nasal tamponade: Due to the need for nasal examination and guidance for treatment or surgery, nasal filling, such as nasal surgery, when hemostasis, the gauze is filled with the nasal cavity; the placement of the medicated cotton pad is checked, but these usually cure the temporary nasal congestion.

Long-term mouth breathing in children with nasal obstruction can cause a series of pathophysiological changes, leading to disturbances in respiratory and digestive system, affecting physical and intellectual development. Such as proliferative hypertrophy caused by nasal obstruction, special face can occur, said proliferative face, if not treated in time, not only affect the child's intelligence, but also cause facial bone development disorders, upper lip tilt, mandibular sagging, nasolabial fold disappear , hard high arch, dentition is not aligned, malocclusion, nasal septum deviation, etc., that is, proliferating face.

an examination

Related inspection

Otolaryngology CT examination general radiography

More common in simple chronic rhinitis. Nasal obstruction is intermittent, alternating, light and heavy, and the lower nasal congestion is heavier when lying on the side.

Differential diagnosis

Intermittent nasal obstruction symptoms need to be identified as follows:

1. The nasal congestion of acute rhinitis develops very quickly, usually reaches a climax within a few days, and it can resolve itself within a week or so, and may be accompanied by systemic symptoms such as fever and dizziness. Acute rhinitis is a common cold.

2, chronic simple rhinitis mostly paroxysmal or alternating, light day and night heavy, often receptor position. In the supine position, the lower nasal nasal congestion is heavier. After the nasal ephedrine syrup is applied, the nasal congestion can be improved for a long time.

3, chronic hypertrophic rhinitis mostly persistent nasal congestion, the net is not sensitive to ephedrine nasal drops, or after the use of nasal congestion improved, only a few minutes after the emergence of hypertrophic rhinitis, if necessary, can consider surgery or use microwave laser To narrow the turbinate.

4, drug-induced rhinitis is general rhinitis, often with ephedrine caused by the insensitivity to nasal drops, or the duration of nasal congestion is shorter, this time should stop using such drugs as soon as possible.

5, allergic rhinitis is accompanied by sneezing, clear water sputum, nasal itching, can be perennial seizures can also be seasonal. Patients with allergic rhinitis can be associated with asthma, especially in children.

6, atrophic rhinitis can be accompanied by nasal mucosa dry, snot with blood, more molting.

7, nasal sinusitis can occur nasal congestion, yellow pus, nasal congestion, may be associated with headache, dizziness, memory loss, etc., can occur after a cold, nasal flow, purulent sputum is not good, sinusitis can coexist with nasal polyps.

8, nasal polyps of the nasal congestion are more persistent progressive, can be unilateral or bilateral, may have symptoms of allergic rhinitis.

9, nasal sinus cysts caused by progressive aggravation, can appear nasal discharge of yellow water-like secretions, can also appear dizziness and so on.

10. The nasal congestion caused by sinus tumors is mostly progressive unilateral or bilateral, and other complications may occur. If you have nosebleeds at the same time, you need to be alert to the possibility of malignant tumors. If there are ear nausea, neck mass, and blood in the posterior iliac crest, it is also necessary to pay attention to the possibility of nasopharyngeal cancer, but it can be confirmed after going to the hospital for examination.

11. The nasal congestion caused by the deviation of the nasal septum is mostly unilateral, and it can also be bilateral, which is more common in young people. It is often characterized by persistent nasal congestion, which may have symptoms of sinusitis, and may also be associated with other nasal diseases such as allergic rhinitis.

12, some patients with nasal congestion may also be narrowed in the nasal valve area, caused by the collapse of the nose.

13, congenital nasal congestion to consider the posterior nostril atresia, children with mouth breathing and sleep snoring, may be adenoid hypertrophy. Unilateral nasal congestion or accompanied by purulent fistula should pay attention to whether there is foreign matter in the nasal cavity.

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