Symptoms (Nose)

Nasal blockage is due to a physical obstruction in the nasal airway. It may be caused by a deviated septum, grape-like tissue growing from the sinuses (polyps), a foreign body or rhinitis, when there is congestion of the lining mucosa. Large adenoids, specific tissue at the back of the nose which produces antibodies, is a common cause in young children. Tumours are also a possible but fortunately very rare cause. Frequent sniffing or forceful intake of nasal air in a person with nasal blockage or congestion over a long time can weaken the alar valves, resulting in collapse on inspiration and additional blockage. Nasal blockage may cause turbulent nasal airflow particularly at night with snoring. If severe it may result in mouth breathing and dryness.

Nasal congestion is a primary symptom of rhinitis due to swelling of the soft tissue lining the nose. Any condition causing nasal blockage may be a contributory factor as well. Rhinitis may be due to specific allergies (allergic rhinitis), infection or a more general sensitivity of the nasal lining (Vasomotor rhinitis). Sometimes the long term use of over-the-counter nasal decongestant sprays is a major factor (rhinitis medicamentosa). Various irritants cause engorgement of blood vessels due to the local release of chemicals (especially histamine) in the tissues. Very frequently there is nasal itching, excessive sneezing and a runny nose (rhinorrhoea).

A runny nose is invariably due to excessive secretions from the nasal glands. It is a common feature of rhinitis and of nasal or sinus infections. Typically it is clear and watery. Thick yellow and green secretions are due to a bacterial or rarely fungal rhinosinusitis, as nasal infections commonly spread to the adjacent sinuses. Frequent nose blowing to clear the excess secretions may cause bleeding (epistaxis). Rarely a persistent watery discharge is due to brain fluid (cerebrospinal fluid – CSF) leaking into the nose and/or sinuses

This invariably results from a nasal injury, when the bones of the nose are broken (fractured) and deviated. Early straightening (reduction) of the displaced bones by outside manipulation within 2 weeks will usually restore a satisfactory symmetrical appearance. Any residual deformity can be corrected by rhinoplasty surgery. A cosmetic rhinoplasty (nose job) may also be considered in people who are dissatisfied with the shape of their natural nose

Nose injuries are common and usually cause bleeding (epistaxis). There may also be blockage due to the collection of blood (haematoma) underneath the lining mucosa. The bones of the nose may be broken (fractured) and displaced resulting in a crooked nose. Squashing the front softer part of the nose may cause twisting of the internal central partition (septum) and blockage.

Sinusitis is infective inflammation of the mucosal lining of one or more of the nasal sinuses. There is invariably associated changes in the lining tissue of the nose, hence the term rhinosinusitis. Swelling of the lining sinus mucosa leads to blocked drainage and ciliary malfunction which interferes with the transport of secretions. This leads to bacterial overgrowth and the production of yellow or green (purulent) mucus and an infective nasal discharge with nasal congestion. The cheek (maxillary) and front nasal bridge (anterior ethmoid) sinuses are commonly affected first, and often causes facial pressure and discomfort. An upper respiratory tract infection (URTI) and allergic rhinitis are common triggers

Loss of Smell (Anosmia)

The three most common causes for a smell disorder are sinonasal disease, after a viral URTI and after a head or facial injury when shearing of the olfactory fibres near the cribriform plate may occur. As the olfactory receptors are at the very top of the nose any condition blocking the passage of air to this area can reduce the sense of smell, such as nasal polyps.