Nasal Breathing Assessment: Finding the Cause

Persistent nasal blockage can have several causes, and more than one may be present at the same time. The aim of a nasal breathing assessment is to identify which part of the nose or nasal lining is contributing to the problem before treatment is selected. Symptoms should not automatically be attributed to a deviated septum or assumed to require surgery.

The assessment may be useful when congestion is persistent, returns frequently, affects sleep or exercise, or does not improve as expected with treatment. The clinician will ask whether one or both sides are affected, whether the blockage alternates, and whether it changes with posture, activity, allergies or time of day.

Structures and conditions that may affect airflow

Examination may assess the nasal septum, turbinates and nasal valve, as well as the lining of the nose. A deviated septum can narrow one side; enlarged turbinates or inflammation can reduce space inside the nose; and narrowing or weakness of the nasal valve can affect airflow, particularly during breathing in. Allergic rhinitis and nasal polyps may also contribute to obstruction.

Nasal endoscopy may be considered when a closer view of the internal nasal passages is needed. The findings help distinguish structural obstruction from inflammation or other causes, and guide whether further investigation is useful.

What information helps the consultation

• Whether blockage is one-sided, both-sided or changes from side to side.
• Any sneezing, itching, discharge, smell loss, nosebleeds or facial symptoms.
• Whether symptoms worsen during sleep, exercise, allergy seasons or when lying down.
• Nasal sprays or medicines used, how long they were used and whether they helped.
• Previous nasal injury, surgery, sinus treatment or relevant scan results.

Treatment depends on the cause

Where inflammation is the main factor, medical management may be appropriate. When a structural problem is responsible for significant obstruction, the discussion may include options such as septoplasty, turbinate treatment or assessment for functional rhinoplasty. The best option depends on examination and the contribution of each structure; not every patient needs a procedure.

This information is general and does not replace an individual medical assessment. Treatment recommendations depend on the cause identified during examination.