EpistemisFixed unilateral nasal obstruction
Specialty: Otolaryngology.
Why it occurs
- Severe anatomical septal deviation (unilateral obstructive cartilaginous or bone ridge or spur)
- Killian's antrochoanal polyp (solitary polyp that emerges from the maxillary sinus and obstructs the choana)
- Malignant sinonasal tumor such as adenocarcinoma or squamous cell carcinoma of the nasal passages
- Unilateral hypertrophy of the inferior turbinate compensatory to contralateral septal deviation or due to local inflammatory processes
- Long-lasting rhinophyte or foreign body with adjacent inflammatory reaction
Initial workup
Detailed nasofibrolaryngoscopy with prior decongestion of the nasal mucosa, CT of the paranasal sinuses in axial and coronal planes without contrast, MRI of the fossae and base of the skull with contrast if a neoplastic-looking mass is identified, and directed biopsy under endoscopic control if appropriate.
red flags
Recurrent unilateral epistaxis of unknown origin, ocular pain or ipsilateral diplopia, progressive loss of visual acuity, facial asymmetry or swelling in the cheek, unexplained upper dental loosening, or presence of persistent pathological cervical lymphadenopathy.
Standard management
- If the obstruction is anatomical (septal deviation, Killian's polyp), the pharmacological treatment is purely symptomatic and presurgical.
- Potent nasal corticosteroids such as fluticasone propionate (200 mcg every 12 hours) to reduce the secondary inflammatory component of the turbinates
- Systemic antihistamines only if there is a concomitant allergic component that exacerbates the general inflammation of the nasal airway.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Otolaryngology
- Listed causes
- 5
- Treatment options
- 3