Adult Nasal Stenosis and Choanal Atresia: Symptoms, Causes, and Relief

Nasal stenosis refers to the narrowing of the nasal passages, which significantly impacts a person's ability to breathe comfortably through their nose. Unlike the temporary congestion felt during a common cold, stenosis is a structural issue. In adults, this narrowing can occur at the nostrils (vestibular stenosis) or deeper within the nasal cavity.

While many patients assume their chronic 'stuffy nose' is simply hay fever or a persistent cold, structural narrowing requires a different clinical approach. According to NHS frameworks, persistent nasal obstruction that does not respond to standard over-the-counter treatments should be formally investigated to rule out stenosis or other anatomical issues like a deviated septum.

Choanal atresia is a congenital condition where the back of the nasal passage (the choana) is blocked by abnormal bony or soft tissue. While most cases are diagnosed at birth, some individuals with 'unilateral' (one-sided) atresia may not be diagnosed until adulthood.

In these cases, the patient may have lived for decades with one permanently blocked nostril, often mistaking it for chronic sinusitis. Because the airway on one side is completely or partially non-functional, it can lead to a significant buildup of thick mucus and a reduced sense of smell. Identifying this in adulthood usually follows a long history of failed medical treatments for supposed allergies.

The symptoms of nasal stenosis and adult atresia can overlap with many ENT conditions. Key indicators include:

• Persistent Nasal Blockage: A feeling of obstruction that never fully clears, regardless of the season or environment.
• Mouth Breathing: Especially during sleep, which often leads to a dry mouth and sore throat in the mornings.
• Thick Nasal Discharge: Mucus that seems to 'pool' behind the blockage rather than draining naturally.
• Reduced Sense of Smell (Anosmia): Airflow cannot reach the olfactory nerves effectively.
• Recurring Sinusitis: Blocked passages prevent the sinuses from draining, leading to frequent infections.

If you find yourself constantly reaching for decongestant sprays with little long-term success, you may be dealing with a structural narrowing rather than simple inflammation.

Structural and Acquired Causes

In adults, nasal stenosis is often acquired rather than congenital. Common causes include:

• Trauma: Previous injuries to the nose that caused internal scarring or collapse of the nasal valves.
• Previous Surgery: Scar tissue (synechiae) following procedures like rhinoplasty or septoplasty.
• Chronic Inflammation: Long-term conditions like sarcoidosis or granulomatosis can cause the nasal lining to thicken and narrow.
• Infections: Severe bacterial or fungal infections can lead to tissue changes and narrowing.

Understanding the underlying cause is essential for determining whether the treatment should be medical or surgical.

In the UK, the pathway for diagnosing nasal airway obstruction usually begins with a primary care assessment. A GP will examine the nose using a speculum to check for obvious obstructions like polyps or a severely deviated septum.

If a structural narrowing like stenosis is suspected, the next step is typically a referral to an ENT (Ear, Nose, and Throat) specialist. Specialists may use a nasal endoscopy—a thin, flexible tube with a camera—to view the deeper structures of the nasal cavity. In cases of suspected choanal atresia, a CT scan is often the gold standard to determine if the blockage is bony or membranous.

The treatment for nasal stenosis depends on the severity and the specific location of the narrowing. NICE guidance suggests starting with conservative management where appropriate, but structural issues often require intervention.

Non-Surgical Management

Saline nasal irrigation and corticosteroid sprays may be prescribed to reduce any secondary inflammation, making the existing airway as clear as possible. Nasal dilators (internal or external strips) can also provide temporary relief during sleep.

Surgical Intervention

For significant stenosis or choanal atresia, surgery is often the only way to restore a functional airway. This may include:

• Stenting: Inserting a small tube to keep the passage open while it heals.
• Scar Tissue Removal: Endoscopic removal of adhesions.
• Nasal Valve Reconstruction: Strengthening the sides of the nose to prevent collapse during inhalation.
• Atresia Repair: Drilling through a bony blockage at the back of the nose to create a new opening.

If you are struggling with a persistent blocked nose that is affecting your quality of life, sleep, or productivity, you can speak to a GP online for a clinical assessment. While structural narrowing requires a physical specialist review for definitive diagnosis, an online doctor can:

• Review your symptoms and medical history.
• Advise on whether your symptoms are likely inflammatory (like rhinitis) or structural.
• Provide a private referral letter to an ENT specialist if structural stenosis is suspected.
• Suggest initial treatments like steroid sprays to rule out common allergies.
• Provide a sick note if your symptoms are significantly impacting your ability to work.

Seeking early advice can prevent the complications associated with chronic mouth breathing and recurrent sinus infections.