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.
This is commonest in the very young and the very old. It may present routinely as a recurrent problem, or in the acute situation when the patient cannot control the bleeding. The latter cases usually result in trivial haemorrhage by clinical standards, but may create a disproportionate amount of alarm. Occasionally, a prolonged nosebleed can cause significant hypovolaemia, especially in the elderly.
Though not usually viewed as a significant symptom, this is very bothersome to those that suffer it. Many of the pathologies overlap with the causes of the ‘Blocked nose’ – please refer to this chapter too, as appropriate. The cause is rarely sinister, but referral for further assessment may be necessary if it persists in spite of treatment.