Nasal Obstruction

What is nasal obstruction?

Nasal obstruction is the sensation of reduced air flow either through one nostril (unilateral) or both nostrils (bilateral).

Why does nasal obstruction happen with facial palsy?

There are muscles around the nostril supplied by the facial nerve, which normally contract when we breathe in, and increase the rigidity of the nostril wall, to help prevent collapse on inspiration (breathing in). Therefore, nasal obstruction in facial palsy tends to occur on the side of weakness on breathing in, but seems better on breathing out. It is more likely to be troublesome if associated with other nasal problems, such as rhinitis (hayfever like symptoms) or a deviated nasal septum. Fortunately, nasal obstruction as a result of facial palsy is uncommon.

How is nasal obstruction diagnosed?

The diagnosis is made in part from the timing of onset in relation to development of facial palsy. On examination, there may be evidence of collapse of the nostril on gentle breathing. However, it is normal to get some inwards collapse of the nostrils when taking a deep breath in through the nose or when sniffing. Examination should also look for other treatable causes of obstruction.

What is the treatment for nasal obstruction?

Treatment involves optimising the nose in relation to other conditions and if necessary aiming to support the nostril.

Rhinitis (inflammation of the lining of the nose) is very common, affecting up to 1 in 5 adults, and causes nasal obstruction and a runny nose. This usually responds well to a steroid nasal spray (which is safe to use long term if needed, as the side effects of taking steroid tablets are avoided) and salt water washing of the nose.

A deviated septum, the cartilage in the middle of the nose, may not necessarily cause problems before facial palsy, but in combination may cause blockage, and surgical correction of the septum is often sufficient to relieve the blockage.

If despite treating other nasal problems the nasal blockage continues, or if there are no other causes, treatment is directed supporting the nostril wall.

The simplest way to do this is with a nasal dilator. There are a number of different products commercially available including nasal strips, airmax nasal dilators or nose cones. They are available from internet retailers or high street chemists. The British Snoring & Sleep Apnoea Association has a wide range available. These are particularly useful if the blockage is more troublesome at night – as the nasal lining swells up when we lie down, it can make the problem worse. Although they only work while the dilators are being used, they are usually well tolerated, and can avoid the need for surgery.

Surgical options include a fascial sling to lift the nostril margin back up, or by strengthening the nostril margin by using cartilage grafts (usually taken from inside the nose). Very few patients with facial palsy will require such surgery, and it should be performed by a surgeon with a special interest in facial reanimation or rhinoplasty.

Last reviewed: 31-07-2019    ||    Next review due: 31-07-2022