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Nasal Block

Nasal Block

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This e book discusses the various causes of nasal block and its management
This e book discusses the various causes of nasal block and its management

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Published by: Dr. T. Balasubramanian on Jun 03, 2010
Copyright:Attribution Non-commercial

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11/07/2012

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Nasal airway obstruction andits management 
 
Dr. T. Balasubramanian
 6/3/2010Otolaryngology onlinedrtbalu
 
 
Nasal air way obstruction and its management
Introduction:Nasal obstruction is an important symptom of many underlying disorders, and is themost common cause for visiting an otolaryngologist. It should be borne in mind thatnasal obstruction is a symptom and not a diagnosis. These patients hence should beevaluated for both subjective / objective nasal obstruction. Nasal patency these dayscan be evaluated objectively based on the anatomy of the nasal cavity and physiologyof nasal air flow which can be studied using a Rhinomanometer.Subjective feeling of nasal block could be due to the following factors:1.
 
Sensitivity of pressure receptors in the nose2.
 
Sensitivity of thermal receptors in the nose3.
 
Sensitivity of pain receptors in the nose4.
 
Presence of excessive secretions in the noseThe cause for nasal obstruction is considered to be multifactorial which includes bothsubjective and objective causes.Anatomic causes of nasal block:Nasal valve area problems: Nasal valve area is considered to be the narrowestportion of the human airway. Anatomically it has two components i.e. External andinternal nasal valves. The anatomy of internal nasal valve was first described byMink in 1903.Boundaries of internal nasal valve include:1.
 
Dorsal portion of nasal septum medially2.
 
Inner caudal edge of upper lateral cartilage laterally3.
 
Anterior head of inferior turbinate posteriorlyThe internal nasal valve area is supposedly the narrowest portion of human airwayhas a cross sectional area of approximately 40
 – 
60 mm
2
. This area accounts fornearly 2/3 of the whole airway resistance. Hence collapse / stenosis of this areaaccounts for one of the commoner causes of nasal block.
 
External nasal valve is also known as nasal vestibule. It is bounded by the caudaledge of the lateral crus of the lower lateral cartilage, fibrofatty tissue over the ala andthe membranous septum.
 
 Diagram showing the nasal valve areasThe nasal vestibule should be considered to be the first component of the nasalresistance mechanism. If the nasal airflow rate exceeds 30 litres / minute, thevestibule of nose collapses causing a reduction in the rate of nasal airflow. Thiscollapse of ala increases the nasal resistance.On inspiration, the increased velocity of air flowing through the nasal valve area willcause a drastic decrease in the introluminal pressure causing a vacuum effect on theupper lateral cartilages. This inward pull causes collapse of upper lateral cartilage(Bernoulli's principle). Total collapse of the internal nasal valve area duing thisscenario is prevented only by the reselience of the upper and lower lateral cartilages.Collapse of external nasal valve area (alar area) is by contraction of dilator narimuscles during inspiration. During expiration the positive pressure prevailing insidethe nasal cavity keeps the nasal valve area open.Causes of nasal obstruction:1.
 
Previous trauma / rhinoplasty surgical procedure are the common causes of nasal obstruction due to weakening of nasal valves2.
 
If there is associated nasal septal deviation then nasal obstruction becomesexponentially increased3.
 
Mucociliary clearance mechanism in patients with deviated nasal septum isslowed considerably when compared to that of normal individuals. Stagnantsecretions inside the nasal cavity may aggravate nasal obstruction

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