Nasal Obstruction Time questions Onset Offset Duration Frequency Getting worse? Seasonal Diurnal -> specific to the day, night or both? Context Anything that triggers it? Describe it. Is it unilateral or bilateral? Non-dynamic -> nasal polyps Alternating -> mucosal inflammation. Severity Aggravating factors Relieving factors Associated features: Purulent rhinorrhoea Facial pain Fever Unilateral nasal obstruction Epistaxis Ear symptoms Paraesthesia Diplopia Trismus Tumor local extension into adjacent structures Prescription medications Non-prescription medications Past medical history General Atopy Dermatitis Surgery Esp. for septal deviation, nasal polyposis (risk of recurrence) or tumor? Family history Social history Smoking -> impair mucociliary clearance and risk of malignancy Alcohol -> vasodilator -> mucosal congestion. Illicit drug use -> nasal drug administration of cocaine -> septal perforation. Occupation -> exposure to hard wood dust e.g. carpenters and wood turners -> predispose to sinonasal carcinoma. Diet Exercise Differentials Allergic rhinitis Allergy Non-allergic rhinitis Infectious Vasomotor Rhinitis medicamentosa Inferior turbinate hypertrophy Adenoid hypertrophy Dru nasal mucosa Medications Anti-thyroid medications Oral contraceptives and other estrogens Ant-hypertensive medications -> BB, CCB, ACE-I, ARBs Internal or external nasal valve incompetence Neoplasms Benign -> e.g. haemangioma, papilloma Malignant -> e.g. nasopharyngeal carcinoma, squamous cell carcinoma, melanoma Empty nose syndrome -> from previous excessive surgery Trigeminal neuropathy Anatomical Choanal atresia Pyriform aperture stenosis Infective HPV Syphilis TB