Abstract
Nasal obstruction is a common presenting symptom of patients seen by primary care
physicians, otolaryngologists, and facial plastic surgeons. A variety of treatment
strategies, both surgical and nonsurgical, have been used with success in improving
nasal obstruction and quality of life. In a subset of patients, many of whom have
either attempted these common treatment strategies or are intolerant of them, nasal
obstruction remains a significant symptom. In these patients, there may be an identifiable
problem, but it is simply not repairable or there is no identifiable anatomic issue.
The management of these patients is discussed in this article, with an emphasis on
a sensitive approach that takes into consideration a patient's mental health. While
the need for diagnostic testing is generally not necessary for most cases of nasal
obstruction, endoscopy and imaging should be considered in these patients. Validated
patient-reported outcome measures are particularly helpful in providing an objective
measure to a patient's frustrating symptoms. A variety of medications can be either
contributory to the patient's symptoms or therapeutic if used appropriately. A variety
of surgical interventions can also result in a functionally crippled nose and diagnoses
including nasal valve stenosis, septal perforations, and empty nose syndrome are discussed.
Importantly, further surgical interventions may not be appropriate if a deformity
is minimal, and a surgeon should resist the temptation to proceed with surgery in
those situations.
Keywords
nasal obstruction - congestion - nasal valve - rhinoplasty
