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Imaging of adult nasal obstruction.

Authors
  • Whyte, A1
  • Boeddinghaus, R2
  • 1 Head and Neck Imaging, Perth Radiological Clinic, Subiaco, WA 6008, Australia; Department of Surgery, University of Western Australia, Nedlands, WA 6009, Australia; Departments of Radiology and Medicine, University of Melbourne, Carlton, Victoria 3000, Australia. Electronic address: [email protected] , (Australia)
  • 2 Head and Neck Imaging, Perth Radiological Clinic, Subiaco, WA 6008, Australia; Department of Surgery, University of Western Australia, Nedlands, WA 6009, Australia. , (Australia)
Type
Published Article
Journal
Clinical radiology
Publication Date
Sep 01, 2020
Volume
75
Issue
9
Pages
688–704
Identifiers
DOI: 10.1016/j.crad.2019.07.027
PMID: 31515050
Source
Medline
Language
English
License
Unknown

Abstract

The commonest causes of nasal obstruction are rhinitis and chronic rhinosinusitis, which affect up to 30% and 14% of the adult population, respectively. The global financial burden is huge, estimated at $5 billion for rhinitis and $8.6 billion for chronic rhinosinusitis per annum in the USA. On referral for imaging, computed tomography (CT) is indicated initially when there is a suboptimal response to medical treatment of these mucosal diseases or there are "red flags," such as persistent unilateral obstruction, epistaxis, pain, and orbital or neurological symptoms. A mass visible at rhinoscopy or endoscopy in the nose or nasopharynx and lymphadenopathy are further indications. The anterior (cartilaginous) nose plays a key role in the aetiology of nasal obstruction as it accounts for 50-75% of the total resistance to airflow in the upper airway. It has been ignored in the imaging literature, but extensively evaluated by clinicians using a range of methods, including CT. Oblique reconstructions perpendicular to the parabolic curve of lamellar airflow provide accurate assessment of the anterior nose. A thorough and systematic approach to assessing the nose addresses the discrepancy between imaging and clinical evaluation of structural causes of nasal obstruction, especially septal deviation, reported in the surgical literature. Nasal tumours are a very uncommon cause of nasal obstruction; magnetic resonance imaging is commonly performed to assess their full extent and improve the specificity of diagnosis. Copyright © 2019 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

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