Nasal obstruction: a common presentation in primary care

Salma Mohamed; Noel Emmanuel; Neil Foden

doi:10.3399/bjgp19X707057

Ear, nose, and throat (ENT) problems make up around 10% of primary care consultations,¹ most of which can be managed effectively in primary care, with a small percentage of cases requiring referral to secondary care. Patients suffering from nasal obstruction often present with a feeling of fullness in the nasal cavity and reduced airflow. A detailed history of symptoms is essential (Box 1), along with its effect on the patient’s quality of life.²

Nasal obstruction

Unilateral or bilateral? (Unilateral obstruction may indicate a structural aetiology, or a possible space-occupying lesion, including foreign bodies such as rhinoliths. Bilateral obstruction may indicate nasal polyposis or mucosal inflammation. However, they are not mutually exclusive).
Timing of symptoms? Diurnal, seasonal (allergic cause), or perennial.
Possible triggers.
Nasal discharge (may signify acute sinusitis).
Epistaxis.
Infective symptoms.
Olfactory disturbance.
Symptoms concerning for neoplasia (unilateral symptoms with epistaxis or a unilateral middle-ear effusion).
History of sinonasal surgery or trauma.

Past medical history

Nasal trauma.
Sinonasal surgery.
Nasal polyposis.
Previous malignancy (possible recurrence).
Atopic conditions.

Medications

Enquire about medications that cause a dry nasal mucosa and over-the-counter decongestants.

Allergy status

Medication and possible allergens.

Social history

Screen for risk factors of nasopharyngeal malignancies (for example, smoking, alcohol).
Exposure to hardwood dust.
Recreational drug use.

Box 1.

History

EXAMINATION

Externally, the relation of the nose with adjacent tissue and structures should be assessed, along with identification of any bony and cartilaginous nasal deformities. Two common methods have been described to assess nasal airflow: the first is occlusion of one nostril and assessing the inflow and outflow through the opposite nostril, and the second uses a metal tongue depressor, observing the misting on the metal surface and comparing the two …

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