Posterior Septal Widening as a Cause of Nasal Airway Obstruction

Nasal airway obstruction, a well-known cause of patient discomfort, is one of the most common presenting complaints to the otolaryngologist. The different causes of nasal airway obstruction are very wide-ranging, spanning from congenital life threatening causes to acquired benign causes. Herein, we present a case of nasal obstruction caused by widening of the posterior septum. A 52-year-old gentleman presented to the rhinology clinic with complaint of chronic nasal congestion for 4 years. Trials of topical steroid sprays and nasal saline rinses had been unsuccessful in symptomatic resolution. On anterior rhinoscopy, the septum was noted to be straight anteriorly, but appeared to be deviated bilaterally, flaring into the nasopharynx and obstructing the airway. A CT scan was performed, which showed soft tissue enlargement on the posterior aspect of the septum. The patient was subsequently taken to the operating room for a posterior septectomy and inferior turbinectomy. He reported alleviation of symptoms postoperatively. It is important for the otolaryngologist to be aware of the myriad of causes of nasal airway obstruction. An accurate history and physical examination including anterior and posterior rhinoscopy is important in the diagnosis of nasal airway obstruction. More importantly, the physician should be aware of the possibility of a widened posterior septum as a cause of nasal airway obstruction.