Diagnosis of Nasal Obstruction

A detailed history is critical in evaluating and treating patients presenting with nasal complaints or requesting nasal surgery. In the history, consider nasal obstruction, chronic or recurrent sinusitis, postnasal drip and cough, facial pressure or pain, ear pressure or pain, hearing loss, loss of sense of smell or taste, halitosis, and other pertinent findings (Table 2). Be sure to ask about environmental allergies and to further evaluate these when appropriate.4 A history of topical nasal-decongestant abuse may cause rhinitis medicamentosa. Note whether there is a history of sinus surgery, rhinoplasty, or other nasal surgery.

Perform anterior rhinoscopy before and after topicalization with a vasoconstricting agent. You may not detect any abnormalities on anteri­or rhinoscopy, or an anatomic abnormality may be observed but not fully appreciated. Perform a nasal endoscopic examina­tion when indicated by patient history or by anteri­or rhinoscopy findings.

Abnormalities and physical findings not apparent on rhinoscopy may appear when careful endoscopy is per-formed by a skilled endoscopist.

With the extensive differential diagnosis of nasal obstruction in mind, I will focus here on technical aspects of 2 commonly performed surgical procedures to address nasal obstruction: septoplasty and turbinate surgery.

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