Nasal obstruction is a common symptom of restricted airflow through the nose. Restricted airflow through the nose can be caused by infection, inflammation, or structural issues such as a deviated septum or nasal polyps. Common symptoms include difficulty breathing, a stuffy nose and snoring.
Common causes of nasal obstruction
Deviated nasal septum
A deviated septum means the nasal septum is off-centre. The septum is the thin wall of bone and cartilage that divides the inside of the nose into two sides. Some people are born with a deviated septum; others develop one after injury.
Mild deviations don’t usually need treatment. More severe deviations may require surgery (septoplasty). Symptoms can include a blocked nose, sinus infections, headaches, nosebleeds, and sleep problems such as obstructive sleep apnoea.
Turbinate hypertrophy (enlarged turbinates)
Turbinates are the long, narrow, bony passageways that help warm and moisten the air flowing through your nose. When they enlarge — acutely or chronically — it’s called turbinate hypertrophy. Common causes include:
- Chronic sinus inflammation
- Seasonal allergies
- Environmental irritants
Turbinate hypertrophy can block airflow and cause nasal congestion, an altered sense of smell, breathing problems, snoring, facial pressure, dry mouth, frequent infections and nosebleeds. Conservative treatment focuses on reducing allergens (dust, mould, pet dander) and using antihistamines or decongestants. If conservative treatment is unsuccessful, surgery may be considered.
Nasal polyps
Nasal polyps are soft, painless, non-cancerous growths that can form inside the nose or sinuses, typically on both sides. They can become irritated and swollen, making nasal breathing difficult.
Nasal polyps are driven by inflammation, though it’s not fully understood why some people develop them. They’re most often seen in people with allergies, asthma, nasal inflammation or recurrent infections, are twice as common in men, and become more likely with age.
Small polyps may not cause symptoms. As they grow, they often resemble peeled grapes — yellow, pink or grey — and can cause:
- Nasal congestion
- Sinus pressure
- Runny nose (rhinorrhoea)
- Nosebleeds
- Headaches
- Loss of taste and smell
- Snoring
- Postnasal drip
If polyps continue to grow, they can block the nasal passages and sinuses — leading to recurrent sinus infections, frequent asthma flares, difficulty breathing, sleep apnoea or other sleep disorders. Medication eases symptoms but doesn’t cure polyps; sinus surgery may be needed to remove them, though recurrence is possible.
Allergic and non-allergic rhinitis
Both involve inflammation and irritation of the nasal lining, causing sneezing, runny nose (rhinorrhoea) and postnasal drip.
Allergic rhinitis is triggered by immune responses to substances such as dust mites, pollen and animal dander (which release histamine). Non-allergic rhinitis is triggered by non-immune factors — smoke, pollution, spicy foods, cold air, hormones. Allergy testing (skin or blood) can confirm or rule out allergic causes.
Treatment focuses on avoiding triggers, controlling the environment (dust control, removing pets) and using over-the-counter or prescription medications such as decongestants and nasal sprays. There is no surgical cure for rhinitis itself, but selected surgeries can ease symptoms — for instance, by addressing anatomical issues or the nerve responsible for nasal drip.
Chronic rhinosinusitis
Chronic rhinosinusitis is inflammation and swelling of the sinuses lasting at least 12 weeks. Mucus can’t drain, the nose becomes stuffy, and the areas around the eyes may feel tender or swollen. Swelling of the sinus lining, infection and nasal polyps may all be involved. Common symptoms include:
- Pain, tenderness and swelling around the nose, eyes, cheeks or forehead
- Thick, discoloured mucus
- Mucus running down the back of the throat (postnasal drip)
- Stuffy or blocked nose, making it hard to breathe
- Reduced sense of taste and smell
Medical treatment includes nasal saline irrigations, corticosteroids and antibiotics. If symptoms don’t improve, functional endoscopic sinus surgery (FESS) may be considered.
Nasal valve collapse or compromise
The nasal valve is the passageway that filters the air you breathe through your nostrils, extending from the middle of the nose to the nostrils. Collapse or compromise happens when the valve narrows, making breathing difficult. It can cause congestion and disturbed sleep. A collapsed valve sometimes looks thinner or sunken — but isn’t always visible externally.
Causes include weakening of the cartilage that supports the valve, anatomical differences (such as a deviated septum or narrow nostrils), trauma, or prior surgery (e.g. rhinoplasty). Nasal valve collapse often requires surgical correction.
Enlarged adenoids
Adenoids are fleshy lumps of tissue at the back of the inside of the nose. They are part of the immune system and produce antibodies that help fight infection. When infected they usually enlarge — and sometimes remain enlarged even after the infection clears. Allergies can also enlarge them.
Symptoms include a blocked, stuffy nose, sleep apnoea, mouth breathing, snoring, sore throat and glue ear (otitis media with effusion). Mild cases may respond to medication; if not, adenoidectomy is commonly recommended.
Nasal tumours and rare causes
Nasal tumours are abnormal growths beginning inside the nasal cavity or sinuses. They can be benign (non-cancerous) or malignant (cancerous), are rare, and become more common over the age of 55.
They occur when the genes that control cell growth become abnormal. Risk is increased by exposure to tobacco smoke, wood or leather dust, and certain chemical vapours (including glue, radium, solvents and formaldehyde).
Symptoms can include nosebleeds, postnasal drip, nasal congestion, pus draining from the nose, facial pain, a visible growth on the nose, face, neck or roof of the mouth, eye problems (such as double vision or bulging eyes) and recurrent infections.
How is nasal obstruction diagnosed?
Nasal obstruction is diagnosed through a combination of medical history, physical examination and — where needed — endoscopic evaluation and imaging (such as a CT scan or MRI). Allergy testing may also be recommended.
When should you see an ENT surgeon?
If you think you might have a nasal obstruction, see your GP first. They’ll assess you and, if appropriate, start a treatment plan. If your symptoms don’t respond to medication, persist for more than one to three months, or interfere with your quality of life, ask for a referral to an ear, nose and throat surgeon.
