Nose and breathing: diagnosis and treatment
A nose you cannot breathe through has 3 possible explanations: something is physically blocking the air, something is inflamed and making the lining of the nose swell, or both at once. The distinction is not a detail, it is the whole treatment. Structure is corrected with surgery, inflammation is treated with medication, and the wrong operation leaves the nose blocked.
What do we treat?
- Nasal obstruction and deviated septum: when your nose is always stuffy, when you breathe through your mouth or when one nostril never works properly. The examination shows whether the cause is a deviated septum, enlarged turbinates or a lining that is permanently swollen.
- Sinusitis and nasal polyps: pressure in the face, thick nasal discharge, a reduced sense of smell. The chronic form cannot be diagnosed from symptoms alone, it also needs an objective finding, because that completely changes the treatment you will receive.
- Allergic rhinitis: sneezing, a clear runny nose, itching, symptoms that come back in the same season every year or are there all year round. It is the most common cause of a stuffy nose and the most often underestimated.
- Sleep apnea and snoring: when breathing during sleep stops or takes effort. The nose is the first part of the airway and often the first that needs checking.
Why are they examined together?
The nose is not a separate organ, it is the entrance to a single airway. Whatever happens there carries on further down. A nose that does not let air through leads to mouth breathing, a dry throat, snoring and broken sleep, and in children it also affects how well the ear is ventilated. That is why a patient who comes in for snoring has their nose examined, and a patient who comes in with a stuffy nose is asked how they sleep.
There is also a second, more practical reason. These 4 conditions cause almost the same symptom, a stuffy nose, and need completely different treatment. Allergy needs to be controlled with medication, polyps need a different approach, a deviated septum needs surgery. Very often 2 of them occur together, and then the order of the steps is what decides the result.
Some patients have already had septum surgery and their nose is still blocked. Often the explanation is that they also had allergic rhinitis that was never brought under control, and that on its own keeps the lining swollen. That is why, when both are present, the allergy is controlled before any decision on surgery, not after.
How is the examination done?
The examination starts with your history, which matters a great deal because it shapes everything that follows: whether the blockage is constant or switches between the 2 nostrils, whether it gets worse in a particular season or environment, what kind of discharge there is and whether your sense of smell has changed.
Nasal endoscopy
It is done with a thin endoscope at the practice, takes a few minutes and does not hurt. It shows the septum along its full length, the turbinates, the condition of the lining, any polyps and whether there is abnormal discharge at the openings of the sinuses. It is the examination that separates structure from inflammation, and without it the distinction is guesswork.
When is a CT scan needed?
It is not needed for every stuffy nose or every episode of sinusitis. International guidelines require chronic sinusitis to be confirmed by an objective finding of inflammation, which can come from the endoscopy or from a CT scan. In practice, endoscopy comes first, and a CT scan is done when the picture is not clear enough or when surgery is being planned.
Allergy testing
When the history points to an allergic component, testing confirms it and shows exactly what the patient reacts to. This matters because it changes both the medication and the steps you take at home and around you, and because it determines what we can realistically expect from any possible surgery.
Frequently asked questions
Not in the first few days. Guidelines set 2 criteria: symptoms that do not improve at all for 10 days or more, or symptoms that get worse within 10 days after they had started to improve. Most episodes are viral and clear up without antibiotics.
Not always. What is needed is objective evidence of inflammation, which the endoscopy can also provide. A CT scan comes in when more information is needed or when surgery is being planned.
It depends on what is blocking the nose. When the cause really is structural, the improvement is clear. When there is also uncontrolled allergic rhinitis, surgery alone is not enough, which is why the allergy is controlled before anything is decided.
Nasal steroid sprays act locally and have a different profile from steroids taken by mouth. They are used long term under medical supervision. What does harm is using decongestant sprays for many days, which makes the lining dependent on them and the blockage worse.
It may be one of the factors, but rarely the only one. The nose is checked first because it is the most accessible part of the airway, but the assessment continues further down.
When should you not wait?
Immediately
Swelling or redness around the eye with fever
A swollen eyelid, pain when moving the eye or double vision during a sinus infection are not a case for the practice, they need emergency care.
Soon
Blockage on one side with bleeding
A nose that is always blocked on the same side, especially with repeated nosebleeds or blood-stained discharge, needs an endoscopy without delay.
Soon
Loss of smell that does not come back
When your sense of smell does not return after a cold or virus, or fades gradually, the cause should be investigated and not put down to habit.
Medical review: Dr. Ioannis KotrotsosENT Surgeon and Specialist in Phoniatrics and Pediatric Audiology.
Πηγή: Payne SC et al., Clinical Practice Guideline: Adult Sinusitis Update, AAO-HNSF, 2025.
The information on this page is for general information only and does not replace a medical examination. For diagnosis and treatment, please consult a doctor.
