Blocked Nose

Differential Diagnosis

Common Diagnoses

Occasional Diagnoses

Rare Diagnoses

  • Iatrogenic (e.g. Doxazosin)
  • Carcinoma of Nose and Sinuses: Squamous Cell, Adenocarcinoma
  • Other Rare Nasal Tumours (e.g. Melanoma, Teratoma)
  • Unilateral Choanal Atresia
  • Fibroangioma of Puberty

Ready Reckoner

Key distinguishing features of the most common diagnoses

Vasomotor RhinitisAllergic RhinitisAdenoidsPolypsSeptal Deviation
Sudden OnsetYesYesNoNoNo
DischargeYesYesPossiblePossibleNo
SneezingPossibleYesNoPossibleNo
UnilateralNoNoPossiblePossibleYes
Previous TraumaNoNoNoNoYes

Possible Investigations

Likely:None.

Possible:Sinus X-rays, allergy tests.

Small Print:FBC, adenoid X-ray, CT scan.

  • Sinus X-rays may be helpful in confirming chronic sinusitis.
  • Allergy tests may identify sensitivities to particular allergens.
  • FBC: Eosinophilia in allergic rhinitis (though rarely required for diagnosis).
  • Adenoid X-ray: Will confirm adenoidal hypertrophy.
  • CT scan defines size and extent of nasopharyngeal carcinoma and sinus pathology.

Top Tips

  • Nasal obstruction is usually the cause rather than the result of recurrent sinusitis. Dealing with the underlying problem may well relieve the sinusitis.
  • Nasal allergy and polyps often coexist. It is worth trying medical treatment to relieve the symptoms before referring for polypectomy.
  • Very sudden nasal blockage with profuse watery rhinorrhoea is likely to be caused by vasomotor rhinitis.
  • If adenoidal nasal obstruction is present with possible hearing or speech difficulties, or possible sleep apnoea, refer with a view to adenoidectomy.

Red Flags

  • Unilateral bloodstained discharge in an older patient with nasal blockage is sinister and suggests malignancy.
  • Soft swelling on either side of the septum following trauma suggests septal haematoma. This should be evacuated to reduce the risk of cartilage necrosis and infection.
  • Check what over-the-counter nasal sprays the patient has been using, remembering the possibility of rhinitis medicamentosa.
  • A toddler with a unilateral nasal blockage and foul-smelling discharge is likely to have a nasal foreign body.

Published: 2nd August 2022 Updated: 10th April 2024

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Based on the best-selling book Symptom Sorter. Pulse Reference is designed to help GPs make sense of patient presentations. It analyses a multitude of symptoms commonly seen in primary care and for each presents differentials, distinguishing features, possible investigations and key points. It also provides guides on managing more than 350 conditions. The perspective is very much grass roots primary care, informed by the latest evidence and guidance.

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Disclaimer

Pulse Reference is based on the best-selling book Symptom Sorter. The experts behind Pulse Reference are Dr Keith Hopcroft who is the co-author of Symptom Sorter, a GP in Essex and Pulse’s editorial advisor and Dr Poppy Freeman, a GP in Camden and also a clinical advisor to Pulse. This website is for clinical guidance only and cannot give definitive diagnostic information. Practitioners should work within the limits of their individual professional practice, seek guidance when necessary and refer appropriately.