Synopsis
Assess fixed and reversible causes of nasal obstruction, explain the limits of medical treatment, and select patients for a shared surgical decision.
- A deviated septum is common and may be asymptomatic; an anatomical finding alone is not an indication for surgery.
- Turbinate tissue changes in size with the nasal cycle and inflammation, so blockage can alternate or fluctuate.
- Ask how obstruction affects sleep, exercise, work and daily comfort before discussing intervention.
Key red flags
Boggy septal swelling with increasing obstruction after trauma or surgery requires immediate assessment for a septal collection.
Investigation priorities
Relate reported obstruction to structural and mucosal findings.
Management branches
A septal deviation is present without important functional nasal obstruction.
- Explain that a bent septum can be left alone when its effect is acceptable to the patient.
- Offer advice about associated rhinitis or irritant exposure if these contribute to intermittent symptoms.
Key medicines
Mometasone furoate nasal spray for associated allergic mucosal swellingWith the 50-microgram Nasonex device, the usual adult rhinitis regimen is two sprays into each nostril once daily, or 200 micrograms daily. Review response and reduce to one spray per nostril daily when controlled; continue only while clinically needed.