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Nasal obstruction is a common complaint encountered in primary care settings, affecting individuals across all age groups. It is often the presenting symptom of a wide range of underlying conditions, ranging from benign etiologies like allergic rhinitis to more serious conditions such as neoplasia. A systematic approach to history-taking and clinical evaluation is vital for accurate diagnosis and effective management. This article aims to provide a comprehensive guide for clinicians to navigate the complexities of assessing nasal obstruction in primary care.
What to ask?
| History Aspect | Rationale | Differential Diagnoses |
|---|---|---|
| Basic History | ||
| Unilateral or Bilateral? | Differentiates between structural and inflammatory causes. | •Unilateral: Space-occupying lesions, foreign bodies. • Bilateral: Nasal polyposis, mucosal inflammation. |
| Timing of Symptoms? | Identifies triggers or underlying conditions based on time. | Diurnal: Hormonal causes. ♦Seasonal: Allergic rhinitis. ♦Perennial: Chronic rhinitis. |
| Neoplastic Concerns | ||
| Factors Suggestive of Neoplasia | Unilateral obstruction with epistaxis or ear symptoms are red flags for neoplasia. Additional symptoms like paresthesia, diplopia, and trismus also raise concern. | Sinonasal tumors, nasopharyngeal carcinoma, and other malignancies. |
| Past Medical History | ||
| Nasal Trauma | Indicates possible structural abnormalities. | Deviated septum, adhesions. |
| Sinonasal Surgery | Past surgeries like septal deviation repair, polypectomy, or tumour removal can influence symptoms and risk of recurrence. | Postoperative complications,... |
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