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Position paper on nasal obstruction: evaluation and treatment

Valero A1, Navarro AM2, del Cuvillo A3, Alobid I4, Benito JR5, Colás C6, de los Santos G7, Fernández Liesa R8, García-Lliberós A9, González-Pérez R10, Izquierdo-Domínguez A11, Jurado-Ramos A12, Lluch-Bernal MM13, Montserrat Gili JR14, Mullol J15, Puiggròs Casas A16, Sánchez-Hernández MC17, Vega F18, Villacampa JM19, Armengot-Carceller M20*, Dordal MT21,22*
(SEAIC Rhinoconjunctivitis Committee & SEORL Rhinology, Allergy and Skull Base Comission)

* Same contribution from both authors

1Servicio de Neumología y Alergia, Hospital Clínic; Immunoal•lèrgia Respiratòria Clínica i Experimental, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); CIBERES Barcelona
2UGC Alergología, Hospital El Tomillar AGS Sur, Sevilla
3Unidad de rinología y asma, UGC Otorrinolaringología, Hospital de Jerez, Cádiz
4Unitat de Rinologia i Clínica de l’Olfacte, Hospital Clínic, Barcelona
5Unidad de Rinología, UGC ORL, Hospital Universitario Puerto Real, Cádiz
6Hospital Clínico-Instituto de Investigación Sanitaria Aragón, Zaragoza
7Unidad de Rinología y Base del cráneo anterior, Servicio de Otorrinolaringología, Hospital Universitario Ramón y Cajal, Madrid
8Hospital Universitario Miguel Servet, Zaragoza
9Servicio de otorrinolaringología, Sección de Rinología, Hospital de Manises, Valencia
10Unidad de Alergia, Hospital del Tórax, Complejo Hospital Universitario Nuestra S. de Candelaria, Santa Cruz de Tenerife
11Consorci Sanitari de Terrassa, Barcelona
12Hospital San Juan de Dios, Córdoba
13Servicio de alergia, Hospital La Paz, Madrid
14Sección de Rinología del servicio de ORL del Hospital Santa Creu i Sant Pau, Barcelona
15Unitat de Rinologia i Clínica de l’Olfacte, Servei d’ ORL, Hospital Clínic i Universitari; Immunoal•lèrgia Respiratòria Clínica i Experimental, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); CIBERES, GA2LEN, EUFOREA, Barcelona
16Hospital Quirón, Barcelona
17UCG Alergología, Hospital Universitario Virgen Macarena, Sevilla
18Servicio de alergia, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria – Hospital Universitario de La Princesa (IP), Madrid
19Servicio de otorrinolaringología y patología cérvico-facial, Hospital Universitario Fundación Jiménez Díaz IDC, Madrid
20Servicio de Otorrinolaringología, Hospital Universitari i Politècnic la Fe, Universitat de València, Valencia
21Unitat d’Al•lèrgia, Badalona Serveis Assistencials, Badalona
22Servei d’Al•lèrgia, Sant Pere Claver Fundació Sanitària, Barcelona

J Investig Allergol Clin Immunol 2018; Vol. 28(2)
doi: 10.18176/jiaci.0232

Nasal obstruction (NO) is defined as the subjective perception of discomfort or difficulty in the passage of air through the nostrils. It is a common reason for consultation in primary and specialized care, and it may affect up to 30-40% of the population. It affects the quality of life (it especially disturbs sleep) and lowers work efficiency.
The aim of this document is to agree on how to treat NO, establish a methodology for evaluating and diagnosing it, and define an individualized approach to its treatment.
NO can be unilateral or bilateral, intermittent or persistent and may be caused by local or systemic factors; these may be anatomical, inflammatory, neurological, hormonal, functional, environmental or medicinal in origin. Directed study of the medical history and physical examination are key for diagnosing the specific cause. NO may be evaluated using subjective assessment tools (visual analogue scale, symptom score, standardised questionnaires) or by objective estimation (active anterior rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow). Although there is little correlation amongst the results, they may be considered complementary and not exclusive. Assessing the impact on the quality of life through questionnaires standardised according to the underlying disease is also advisable.
NO is treated according to its cause. Treatment is fundamentally pharmacological (topical and/or systemic) when the aetiology is inflammatory or functional. Surgical treatment may be necessary when medical treatment fails, to complement or improve it or when other therapeutic approaches are not possible. Combinations of surgical techniques and medical treatment may be necessary.

Key words: Nasal obstruction/nasal blockage/nasal respiratory insufficiency, Objective subjective evaluation, Acoustic rhinometry, Rhinomanometry, Medical and surgical treatment