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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 Committee)

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

J Investig Allergol Clin Immunol 2018; Vol 28(2) : 67-90
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 may affect up to 30%-40% of the population. It affects quality of life (especially 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, which may be anatomical, inflammatory, neurological, hormonal, functional, environmental, or pharmacological 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 analog scale, symptom score, standardized questionnaires) or by objective estimation (active anterior rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow). Although there is little correlation between the results, they may be considered complementary and not exclusive. Assessing the impact on quality of life through questionnaires standardized 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 etiology is inflammatory or functional. Surgery may be necessary when medical treatment fails to complement or improve medical treatment 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 and subjective evaluation, Acoustic rhinometry, Rhinomanometry, Medical and surgical treatment