Differential Diagnosis of Nasal Blockage

Presented by Dr. Nikhil Mali

Nasal congestion is the blockage of the nasal passages usually due to membranes lining the nose becoming swollen from inflamed blood vessels It is also known as nasal blockage, nasal obstruction, blocked nose, stuffy nose, or stuffed up nose.

Nasal congestion can interfere with the ears, hearing, and speech development. Significant congestion may interfere with sleep, cause snoring, and can be associated with sleep apnea. Nasal congestion can also cause mild facial and head pain, and a degree of discomfort.

Nasal blockage can be seen in the following Diseases

Common cold The onset is acute, with a scratchy sore throat and cough. The nasal mucosa will appear red, boggy, and glassy. The nasal drainage will initially be clear but will later become colored (yellow-green).  

Allergic rhinitis Acute allergic rhinitis is often associated with eye irritation, paroyxms of sneezing, itching of the eyes, nose, or palate, and postnasal drip with cough. The nasal mucosa is bluishand pale. Seasonal rhinitis is usually caused by inhaled pollens. Perennial rhinitis is caused byallergy to animals, dust, mites, or mold.

Vasomotorrhinitis Congestion is prominent, but rhinorrhea, sneezing, and itching are not. Rhinitis medicamentosa occurs after 3 to 4 days of continuous use of a topical vasoconstrictor.

There will be initial relief with its use that is then followed by rebound with worsened congestion. Vasomotor rhinitis may also be precipitated by cold, emotion, or sexual arousal. The turbinates are red and boggy.

  Nasalpolyp Unilateral airflow will be obstructed and a polyp will be visible deep inside, beyond the turbinate, as a gray structure with the appearance of a skinned grape. There is an associationbetween aspirin use, nasal polyps, and asthma, but the most common cause is chronic allergic rhinitis.

Sinusitis Drainage, if present, will be purulent, although colored drainage can be found in otherconditions. There will be a sensation of facial fullness that worsens with bending forward, oftenaccompanied by fever and a headache.

On physical examination, there will be tenderness toconcussion and pressure, overlying warmth, and fever. The affected sinus will not transilluminate.

Drugs Cocaine, beta-blockers, reserpine, and hydralazine can each cause nasal obstruction

Deviated septum Deviation causes chronic unilateral obstruction, which is readily observed with a nasal speculum.

Intranasal foreign body There will be nasal obstruction associated with a chronic unilateral mucopurulent discharge with a foul odour.

SarcoidosisSarcoidosis presents with bilateral nasal congestion in as many as 20% of cases. Systemic symptoms such as fever, fatigue, or weight loss; pulmonary symptoms such as cough ordyspnea; or skin manifestations such as erythema nodosum or purple, waxy plaques are clues tothe underlying diagnosis.

Cerebrospinal fluid leak Head trauma with a basilar skull fracture may go unrecognized. Clear nasal drainage tests positive for glucose using a urine dipstick.

Wegener granulomatosis   Wegener granulomatosis Its earliest manifestation may be nasal obstruction, rhinorrhea, crusting,and chronic sinusitis with a fetid drainage. Development of a septal ulceration is present

Causes of Nasal blockage

Allergic reaction Common cold or influenza Deviated septum Hay fever, allergic reaction to pollen or grass Reaction to medication (e.g. Flomax) Sinusitis or sinus infection

Treatment

The treatment of nasal congestion frequently depends on the underlying cause. Both influenza and the common cold are self limiting conditions that improve with time; however, drugs such as acetaminophen (paracetamol) and ibuprofen may help with the discomfort.

A cause of nasal congestion may also be due to an allergic reaction caused by hay fever, so avoiding allergens is a common remedy if this becomes a confirmed diagnosis. Antihistamines and decongestants can provide significant symptom relief although they do not cure hay fever.

Topical decongestants should only be used by patients for a maximum of 3 days in a row, because rebound congestion may occur in the form of rhinitis medicamentosa The use of nasal irrigation may help reduce nasal congestion. It involves rinsing the nasal cavity with salty water, however, this may cause further irritation.

Vaporisers These are obtainable in ointment and oil form and have scented constituents that could assist in allaying a dripping nose or finding relief from the ‘stuffed or suffocated feeling’ by de-clogging the inflammation in the air passages. Eucalyptus and oils like peppermint, menthol, camphor act on the nasal receptors, constrict the flow of blood and hence lower inflammation.

Menthol-based nasal strips The placing of these strips is done below the nasal bridge for allaying obstruction as it lifts open the nostrils. The menthol helps to relieve inflammation in the air passages.. Their strong-smelling nature helps to infiltrate the mucus obstruction, thus help to provisionally open the nasal passages.

Nasal Sprays These sprays have decongestants like oxymetazoline or xylometazoline that contract the blood vessels. They additionally aid in stopping mucous formation

list of surgical procedures is shown below. Turbinectomy Partial turbinectomy Submucosal resection of the turbinates Surface "scoring" techniques Less invasive techniques

"Hot poker" methods (electrocautery, radiofrequency, laser) Powered/submucous inferior turbinoplasty FESS (Functional Endoscopic Sinus Surgery) Septoplasty

According to Ayurveda नासावरोध

नासाप्रतीनाह

Samprapti: कफव्रुतो वायुरुदानसंद्न्यो यदा स्वमार्गे विगुणः स्थितःस्यात्। घ्राणं व्रुणोतीव तदा स रोगो नासाप्रतीनाह इती प्रदिष्टः॥ सु.उ.२२/१५

Laxanas नासावरोध सकष्टश्वसन मुखेन श्वसन तालुशुष्कता

Chikitsa स्नेहपान स्निग्ध धूम शिरोबस्ति स्नेहन स्वेदनादि उपचार्

अपीनस

कफपरवरधदो नaसायां रुध्द्वा स्रोतांस्यपीनसम्। Samprapti: कफपरवरधदो नaसायां रुध्द्वा स्रोतांस्यपीनसम्। कुर्यात्सघुर्घुर्ं श्वासं पीनसाधिकवेदनम्॥  

नासावरोध, घुर्घुरं श्वास, पिच्छिल पीत पक्व स्राव Laxanas नासावरोध, घुर्घुरं श्वास, पिच्छिल पीत पक्व स्राव  

Chikitsa स्नेहन, स्वेदन, वमन, विरेचन, धूमपान, अवपीडन नस्य

नासाशोष

शोषयेन्नासिकास्रोत्ः कफं च कुरुते अनिलः। शुकपुर्णभनासात्वं.........॥ वा.सु. १९/१६ Samprapti:

Laxanas नासावरोध नासाशुष्कता सकष्टश्वसन, नासाविदारण शुकपुर्णभनासत्वं

Chikitsa स्नेहपान, स्निग्ध धूम स्वेदनादि उपचार्  

पुटक

Samprapti: पित्तश्लेष्मावरुधः अतर्नासायां शोषयेन्मरुत्। कफं सशुष्कपुटताम् प्राप्नोति पुट्क्ं तु तत् ॥ वा. उ. १९/२५

Laxanas पुटकोत्पत्ति नासावरोध नासाशुष्कता सकष्टश्वसन  

Chikitsa स्नहपन सनगध धूम प्रधमन नस्य नाडीस्वेद

नासार्श  

Samprapti: दोषैस्त्रिभिस्तैः प्रुथकश्च ब्रुयात्तथः अर्शासि तथैव शोफाम्। सु.उ.२२/१८

Laxanas नासावरोध सकष्टश्वसन शिरःशूल सानुनासिकउच्चार

Chikitsa शस्त्रकर्म

प्रतिश्याय

चयं गता मूर्धानि मारुतादयः प्रुथकसमस्ताश्च तथैव शोणितम्। Samprapti: चयं गता मूर्धानि मारुतादयः प्रुथकसमस्ताश्च तथैव शोणितम्। प्रकोप्यमाणां विविधैः प्रकोपणैन्रुणां प्रतिश्यायकरा भवन्ति हि॥ सु.उ.२४/४

Chikitsa स्नेहन स्वेदन वमन धूम गण्डूष

Presented by Dr. Nikhil Mali