Blocked Nose

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
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.
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