Nasal block (Adult)

Nasal block is a very common presentation to ENT services. There are many causes of nasal block but the first to consider is the normal physiology and nasal cycle. The nasal cycle occurs roughly every 8 hours one side will have more resistance that will then alternate and therefore seem more blocked. This is entirely normal and doesn’t need treatment.

Many patients will have had their symptoms for years and it is important to try and identify why they seek medical advice at this stage.

Please identify if there are any red flags associated with the nasal block (unilateral bloody discharge, cacosmia (everything smells foul), bleeding, paraesthesia over the cheek, change in vision or dentition, neurological symptoms).

Causes of nasal block and primary care management

• Traumatic / Structural
  • In an acute traumatic incident please see referral criteria below and nasal trauma guidance.
  • If over 3 weeks since injury or long standing structural cause then trial a topical nasal steroid, many will have an improvement.
• Allergic rhinitis
  • Nasal block with associated nasal discharge and allergic symptoms such as sneezing/watery itchy eyes then it is likely to be an allergic component.
  • Try to identify the triggers and patients should avoid these
  • Trial saline rinse plus a topical nasal steroid spray as per NHS Tayside formulary
• Chronic rhinosinusitis
  • Nasal block with associated coloured discharge, change in smell are the cardinal symptoms of chronic rhinosinusitis
  • Management is based on the EPOS guidelines- see flow diagram
    • Intranasal corticosteroids
    • Saline rinses
    • Educate on technique of sprays and saline rinses
    • Try to avoid antibiotics unless clear indication of acute infection
  • If nasal polyps are seen or known previously then follow NHS Tayside nasal polyp management guideline.

Emergency

• If nasal block as a result of nasal trauma refer within 3 weeks of injury (see nasal trauma guidance).
• If nasal trauma more than 3 weeks ago wait until 6 months to assess then refer if still symptomatic.

Routine

• Refer if the above management plan isn’t working. Often the topical treatment will need at least 6 weeks to see if there is any improvement.

Urgent

• If the patient has associated red flag symptoms.

Nasal drops patient leaflet

• European position paper EPOS
• Allergic rhinitis and its impact on asthma ARIA
• EPOS 2020: Care pathways for acute rhinosinusitis