The nasal cavity is divided into right and left nasal passages by the nasal septum. If the septum is bent, airflow through the nose can be reduced. Nasal trauma is a common cause for a bent septum, and, if occurring in childhood, may be long forgotten until the individual presents to the ENT surgeon later on with a blocked nose. Injury to the growing nose in the child may result in further deviation on maturity. The nasal bones and cartilage are considered to be fully developed by age 16.
ENT surgeons have traditionally postponed surgery on the nose before this age. Recently, however, good results have been obtained in cases of nasal trauma in children with septal haematoma by using a synthetic PDS foil (Treatment of septal haematomas and abscesses in children. Menger DJ, Tabink I, Nolst Trenité GJ. Facial Plast Surg. 2007; 23:239-43).
Another common reason for a blocked nose is congestion or enlargement (hypertrophy) of the mucosal lining of the nose that is located on the lateral or outer parts of the nasal cavity, opposite the septum. Congestion can be dynamic, and may vary with season, environment, posture, ambient temperature. It is also normal for the nostrils to show an alternating congestion due to the inherent nasal cycle. A blocked nose is one of the commonest manifestations of nasal allergy (‘hay fever’). Watery secretion form the nose, itching or sneezing attacks are other common signs of nasal allergy. Individuals with a family history of allergy (such as hay fever, asthma or eczema) are at an increased risk of developing nasal allergy. Individuals with nasal allergy are at a threefold risk of developing asthma (Agius AM, Cordina M, Calleja N. The role of atopy in Maltese patients with chronic rhinitis. Clinical Otolaryngology 2004 29(3), 247-253).
The treatment of turbinate congestion is usually medical, by means of sprays (usually steroid sprays), while the treatment of a deviated septum is surgical (see FAQ’s Septoplasty). In many cases, both elements are present. Also, if medication cannot enter the nose due to excessive congestion of the turbinates, it will not work-hence the turbinates may have to be reduced in one of a variety of ways.