Differential diagnosis of nasal obstruction

1. DR RAJASHRI MANE
PROF & HOD ENT
D. Y. PATIL MEDICAL COLLEGE
KOLHAPUR, INDIA.

2.  Definition
 A sense of blockage/ obstruction with in the nose or
difficulty breathing out from one or both nostrils.

3. NASAL OSTRUCTION
I) UNILATERAL
 INTERMITTENT
 CONTINUOUS
II) BILATERAL
 INTERMITTENT
 CONTINUOUS

4. Differential diagnosis of nasal obstruction
Causes of unilateral nasal obstruction
1.Structural: DNS, inf.turbinate
hypertrophy,concha bullosa
2.Infection: Unilateral sinusitis
3.Polyp: Antrochoanal polyp
4.FB
5.Neoplasms
6.Congenital:choanal atresia
7.Trauma
8.Granulomatous Dx:Rhinoscleroma
Causes of Bilateral Nasal obstruction
1.Infection:
-Acute rhinitis
-CRS, Atrophic rhinitis
2.Allergy:Allergic rhinitis
3.Non allergic,non infective:
Vasomotor rhinitis
4.Adenoid hypertrophy
5.Structural: DNS
6.Trauma:Septal hematoma
7. Ethmoidal polyposis
8.Neoplasms
9.Rhinitis medicamentosa

5. UNILATERAL NASAL OBSTRUCTION
CONTINUOUS
1. DNS
2. Antrochoanal Polyp
3. FB nose, Rhinolith
4. Benign lesions of maxilla
extending to nasal cavity eg.
Maxillary cyst,
Dental Cyst,
Dentigerous Cyst,
5. Rhinosporidiosis
6.Inverted Papilloma
7. JNA
8. Malignancy
9. Choanal Atresia
 INTERMITTENT
1. Hypertrophy Turbinate
Middle / Infeerior
2.Sinusitis

6. BILATERAL NASAL OBSTRUCTION
Continuous
1. Adenoids
2. DNS
3. Ethmoidal polyps
4. Atrophic rhinitis
5. Septal Heamatoma
6. Septal abscess
7. Rhinoscleroma
8. Neoplasm
9. Bilateral Choanal Atresia
 Intermittent
1. Sinusitis, CRS
2. Allergic Rhinitis
3. Vasomotor Rhinitis
4. Acute Rhinitis
5. Rhinitis Medicamentosa

7. How to Evaluate?
ENT examination
1. External Pyramid
2. Anterior Rhinoscopy
3. Posterior Rhinoscopy
4. Cold Spatula Test
5. PNS tenderness

8. External Pyramid
1. Root
2. Dorsum
3. Tip
4. Ala
5. Columella

9. Anterior rhinoscopy(ARS):
 Nasal mucosa- pale/congested/bluish
 Septum- deviated/straight/perforated
 Lateral wall- inferior and middle turbinates & meati
 Floor-Any growth/polyp/presence of mucopus

10. Posterior rhinoscopy(PRS):
 Choana
 ET orifice
 Fossa of Rosenmuller
 Roof of nasopharynx
 Soft palate

11. Paranasal sinus(PNS):
 Inspection- oedema/cellulitis
 Palpation- tenderness of
frontal/ethmoid(R/L)/maxillary(R/L)

12. COLD SPATULA TEST
AIR BLAST TEST

13. INVESTIGATIONS
1.X-RAY PNS Water’s view
Caldwell’s view
Submentovertical view
2. x-ray Soft tissue Nasopharynx
3. Diagnostic Endoscopy
4. CT Scan PNS

18. THANK
YOU.