Nasal Atresia and Stenosis in Adults: Symptoms and UK Care

Nasal stenosis is a condition where the nasal passages become abnormally narrow, leading to chronic respiratory discomfort. While many UK patients associate a 'blocked nose' with common ailments like the cold or hay fever, stenosis represents a structural narrowing that does not resolve with standard decongestants. In adults, this is often acquired rather than congenital.

Acquired nasal stenosis typically occurs at the nasal valve—the narrowest part of the airway—or within the nostrils (vestibular stenosis). When the passage is completely blocked by tissue or bone, it is referred to as atresia. While choanal atresia is usually diagnosed shortly after birth, adults may develop narrowing due to trauma, infection, or as a complication of medical procedures.

The symptoms of nasal narrowing can be subtle at first but often progress to significantly affect quality of life. Patients in the UK frequently report the following:

• Chronic Nasal Obstruction: A feeling that the nose is constantly blocked, often affecting one side more than the other.
• Mouth Breathing: Due to restricted airflow, patients may naturally default to breathing through their mouth, leading to a dry throat and cracked lips.
• Sleep Disturbances: Narrowed airways are a primary contributor to heavy snoring and can exacerbate obstructive sleep apnoea symptoms.
• Reduced Sense of Smell: Impaired airflow prevents odour molecules from reaching the olfactory nerves at the top of the nasal cavity.
• Exercise Intolerance: Finding it difficult to breathe sufficiently through the nose during physical activity.

Understanding why the nasal passage has narrowed is the first step toward effective treatment. According to NHS clinical knowledge summaries, structural changes in the nose can result from several factors:

1. Trauma and Injury

A broken nose or significant impact to the face can cause the internal structures to shift or heal incorrectly, leading to a deviated septum or collapsed nasal valves.

2. Post-Surgical Scarring

Procedures such as rhinoplasty or the removal of nasal polyps can occasionally result in the formation of synechiae (adhesions). This is where scar tissue bridges the nasal cavity, physically narrowing the gap.

3. Chronic Inflammatory Conditions

Long-term inflammation from conditions like granulomatosis with polyangiitis or even severe, untreated chronic rhinosinusitis can eventually lead to tissue thickening and stenosis.

If you are struggling with a persistent blocked nose that has lasted longer than three weeks, it is advisable to seek medical advice. While many UK patients wait months for an ENT referral, an online doctor UK service can provide an initial assessment to rule out common causes like allergic rhinitis.

A GP consultation is particularly useful if you have a history of nasal surgery or injury. During a video consultation, a doctor can discuss your symptom history and advise whether your concerns align with NICE guidelines for specialist ENT referral. We can also provide private prescriptions for steroid nasal sprays to reduce any inflammatory component of the blockage, helping to determine if the issue is purely structural or partially related to swelling.

In the UK, the diagnosis of nasal stenosis involves a physical examination, often using an otoscope or an endoscope (a thin camera) in a clinical setting. Imaging, such as a CT scan, may be used to assess the extent of the narrowing deeper in the nasal vault.

Non-Surgical Management

For mild cases, doctors may recommend:

• Saline nasal douching to keep the passages clear.
• Internal nasal dilators to physically prop open the nasal valve during sleep.
• Prescription corticosteroid sprays to minimise tissue inflammation.

Surgical Options

If structural narrowing is severe, surgery is often necessitated. Common procedures include septoplasty to straighten the midline or alar batten grafting to reinforce a collapsing nasal valve. These procedures aim to restore the 'functional' airway, improving both breathing and sleep quality.