Blocked Nose

This extremely common symptom is very familiar to all GPs. The most frequent cause, the common cold, is not included here, since nasal obstruction in itself is not usually the presenting symptom. The majority of causes of nasal obstruction are benign, but care should be taken to consider referral in those few cases that do not respond promptly to simple treatment.

Published: 2nd August 2022 | Updated: 15th August 2022

Differential diagnosis

Common Diagnoses

  • Vasomotor Rhinitis
  • Allergic Rhinitis (Seasonal and Perennial)
  • Nasal Polyps
  • Adenoidal Hypertrophy (in Children)
  • Nasal Septal Deviation (May Affect 20% of Adults)

Occasional Diagnoses

  • Overuse of Over-the-Counter Nasal Decongestants (Rhinitis Medicamentosa)
  • Chronic Sinusitis
  • Papilloma
  • Trauma (Including Septal Haematoma)
  • Foreign Body (Especially Toddlers)

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
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.
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Website 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.