Persistent Nasal Obstruction: Allergy, Chronic Sinusitis or a Deviated Septum?

Persistent nasal obstruction does not necessarily indicate sinusitis. Common causes include allergic rhinitis, chronic rhinosinusitis, and structural abnormalities such as a deviated nasal septum.

Allergic rhinitis typically presents with nasal congestion accompanied by sneezing, rhinorrhea and nasal itching, often following exposure to relevant allergens.

Chronic rhinosinusitis should be considered when symptoms persist for more than 12 weeks. Nasal obstruction or discharge is characteristic, while facial pain or pressure and a reduced sense of smell may also occur.

A deviated nasal septum is a structural displacement of the wall separating the nasal passages. When clinically significant, it may restrict airflow and contribute to persistent obstruction. Other structural causes include turbinate enlargement and nasal polyps.

Symptoms alone may not establish the underlying diagnosis. Evaluation may include examination of the nasal cavity, with nasal endoscopy or computed tomography used when clinically appropriate.

Persistent unilateral obstruction deserves particular attention, especially when associated with bleeding or other unusual symptoms, as further investigation may be required to exclude alternative causes.