02/11/2011 in article
Included in this category are deformities of the nasal septum, the thin cartilage and bone that divide the nose into its two sides. These deformities can be congenital or can be due to an injury at some point in the patient’s life, including during birth. Deformities of the nose and nasal septum are common findings, and do not cause nasal obstruction in all patients. Surgery can correct the problem when the deviation is severe enough to produce obstruction.
One of the most common causes of nasal obstruction in children is enlargement of the adenoids, tonsil-like tissue that fills the back of the nose above the soft palate. This tissue shrinks in most children by age 12, which explains why this is a much less common problem in adults. Children with adenoidal hypertrophy are chronic mouth breathers, often breathe noisily at night and may snore. Surgery to remove the adenoids may be required in these situations.
Nasal polyps are smooth, pale, grape-like benign masses, which can grow in the nose, resulting in partial or near total nasal obstruction. Polyps are commonly associated with asthma in adults, and raise the suspicion of cystic fibrosis in children. The cause of nasal polyps is unknown, but they may be allergy related. By far, the most common cause of nasal polyps is chronic sinusitis. The lining of these cavities thickens and expands into the nose leading to partial or complete nasal obstruction. Treatment of nasal polyps often requires nasal and sinus surgery for removal.
The turbinates are small thin bones covered with mucus membrane, found on the lateral nasal wall. The inferior turbinates in particular protrude into the nasal airway, forming part of the so-called nasal valve, the primary site of nasal obstruction. Swelling or hypertrophy of the inferior turbinates is a common cause of nasal congestion. Reversible swelling of the mucous membranes often respond to intranasal steroids. When the changes are not responsive to medical therapy, a variety of procedures are used to reduce the mass of the turbinate protruding into the airway.
Children are prone to inserting a remarkable variety of objects into their nose. When unilateral foul smelling nasal discharge is present, a foreign body must be suspected. Tumors of the nasal cavity, both benign and malignant, are relatively rare, but must always be considered, particularly when the obstruction is unilateral.
Nasal congestion is a common problem caused by a large array of disorders. We will discuss allergies and vasomotor rhinitis in the next installment.