Nasal Obstruction (Stuffy Nose)

Nasal obstruction is one of the most common otolaryngologic complaints. Causes are categorized as structural (septal deviation, inferior turbinate hypertrophy, nasal valve collapse, choanal atresia, septal perforation), mucosal/inflammatory (allergic and non-allergic rhinitis, chronic rhinosinusitis with or without polyps, vasomotor rhinitis) and neoplastic (inverted papilloma, juvenile angiofibroma, esthesioneuroblastoma, nasopharyngeal carcinoma).

Pathophysiology depends on etiology: structural causes reduce cross-sectional area, inflammatory causes produce mucosal edema and hypersecretion, and tumors create mass effect. Symptoms typically include unilateral or bilateral airflow reduction, mouth breathing, snoring, sleep-disordered breathing, hyposmia and rhinorrhea. Pediatric obstruction often involves adenoid hypertrophy.

Clinical evaluation includes anterior rhinoscopy, flexible nasal endoscopy, allergy testing and CT paranasal sinuses for chronic or asymmetric cases. Acoustic rhinometry and rhinomanometry quantify airflow objectively. Red flags include unilateral epistaxis, persistent unilateral obstruction with crusting, cervical lymphadenopathy and cranial nerve deficits suggesting malignancy.