Nasal obstruction is one of the most common issues evaluated by paediatric ENT doctors. Prompt treatment of nasal obstruction in newborns and infants is crucial as it can hinder breathing and become life-threatening. Nasal obstruction in older kids is mainly due to other causes such as nasal lining inflammation, infectious diseases, or traumatic causes. Nasal obstruction can lead to a significant decrease in the quality of life as well as bring about an increase in health care expenditure in children. The ENT Clinic provides quality ENT diagnosis and treatment in Singapore. Located conveniently at Mt. Elizabeth Novena Center and Gleneagles Hospital, the ENT Clinic is a trusted medical practice for both locals and expats.

What is nasal obstruction?

The nasal passage helps the passage of air through the nostril to the throat. This is a vital function to maintain life. Nasal obstruction occurs when there is a complete or partial blockage in the nasal passage.

What is the impact of nasal obstruction?

When there is nasal obstruction, there is a decreased ability for the children to breathe either through one or both sides of the nose. In addition, there could be difficulty sleeping as well. Mouth breathing, snoring or a chronic runny nose may also be present.

What are the symptoms of nasal obstruction?

Nasal obstruction in a newborn can be noted right after birth. The infants breathe mainly through the mouth when there is a blockage.  There would be noisy breathing. There is frequent crying in infants too who have nasal obstruction. Crying can improve the rate of breathing. Breathing problems in children with nasal obstruction are noticeable during feeding. Older children, who have nasal obstruction may have a runny nose and the mouth may be open.

What are the causes of nasal obstruction?

Nasal obstruction may occur due to many reasons. Some of the causes could be due to a birth anomaly. The other causes are ones acquired later in life. The specific causes can be determined by the age of the child. Nasal patency helps to measure how open the nose is and it comprises the cross-section area of the nasal cavity. It is however not equivalent to the airflow or resistance to airflow.

Some of the other reasons for nasal obstruction include:

Colds and Flus: Respiratory tract infections can cause an inflammation and swelling of the nasal lining, and it is characterised by a runny nose. Stuffiness of the nose, in this case can be transient due to the flu symptoms. Flus and colds are caused by different viruses and it can lead to a blocked nose.

Rhinitis: This can be caused by allergens as well as chemical irritants such as smoke which can cause inflammation in the nasal lining. Rhinitis in infants can cause a lot of distress and it is important that cases of chronic rhinitis are evaluated by an ENT doctor in a timely manner. The ENT specialist may sometimes order more tests to confirm the condition.

Large or swollen turbinates: The bones which are found inside the nose can be large or it could get swollen due to an allergy. Kids generally have infections due to their poor immune systems. This can result in nasal obstruction.

Large adenoids: The adenoids are glands which are present behind the nose and above the mouth’s roof. It is common for children to have enlarged adenoids and it could occur due to an infection. Certain children could also be born with an enlarged adenoid. As they get bigger, the adenoids too would enlarge causing difficulty in breathing and snoring.

Nasal polyps: These are an overgrowth of tissue which protrudes from the sinus lining into the nasal passage. Such kinds of polyps are the result of an infection or a chronic irritation. The otolaryngologist generally evaluates it using an X-ray.

Tumours: During rare instances tumours can be a cause of nasal obstruction. These tumours could be due to benign or malignant tumours. It can bring about stuffiness on one side of the nose and may cause bleeding, drainage or swelling. For a proper diagnosis the nasal specialist may order an X-ray.

How is nasal obstruction diagnosed?

The examination done for nasal obstruction would take into account the dynamics of airflow. At first the ENT specialist would perform an external examination of the nose, followed by examination of the internal anatomy. The medical history of the child would be taken to understand if it is uni / bilateral, the severity of the condition as well as what triggers nasal obstruction.

The external examination which is conducted, must concentrate on the bone or cartilage deformities as well as if there is any tissue in the adjacent tissues. The ENT doctor would also examine for any  nasal tip ptosis. Examinations of airflow would also be done during normal as well as during deep inspiration. Checks will be done to see if there is a collapse of nasal valves. The ENT doctor in a general practice setting does the ‘pig nose’ manoeuvre and the doctor will be able to examine the calibre of the turbinates and the nasal septum position. If the diagnosis is not too clear, then the patient may need a nasal endoscopy. This procedure requires the nasal cavity to be prepared topically using a decongestant and local anaesthesia.

The doctor would also check to see if there is any ear effusion or lymphadenopathy. Clinical history and examination would help to identify nasal obstruction in most cases. Apart from this, imaging techniques such as CT and MRI scans may be used to obtain preferred imaging. It helps to obtain imaging of the sinuses and their drainage pathways. In addition, the doctor may order blood tests if an allergy is suspected.

How is nasal obstruction managed?

The management of nasal obstruction in children is based on the underlying cause. If the obstruction is due to an anatomical abnormality, then a surgical intervention is the solution. For most cases of nasal obstruction, the first line of management would include medicines being prescribed. For instance in the case of allergic rhinitis, intranasal steroids may be prescribed. There are steroid sprays which can be used. Cases of rhinosinusitis are managed usually with a combination of saline rinse and intranasal steroids. The steroid helps to reduce symptoms and is also used in treating nasal polyps. This helps to reduce the size of the polyps.

Thus, both acute and chronic nasal obstruction can occur due to a number of causes. While most cases can be diagnosed by a physician, there are others, which need specialist ENT intervention, for example if the cause is anatomical and when symptoms are resistant to medical treatment.