Measuring the breath of life

The inability to breathe freely and clearly is a major source of concern to patients and a common symptom in many sinonasal conditions (1). There are of course some semantic differences between terms such as ‘obstruction’, congestion’ and ‘blockage’, which have to be clarified when taking a clinical history as the presence of inflammation may produce the sensation of congestion without actually being associated with mechanical obstruction to airflow (2). Notwthstanding this, nasal obstruction is the commonest complaint in chronic rhinosinusitis with and without nasal polyps (3) and is a major feature of conditions from the common cold and acute bacterial rhinosinusitis to allergic and non-allergic rhinitis, septal deformity or a tumour. Paradoxically, many people, myself included, go through life largely oblivious to a significant septal deflection. It therefore begs the question as to why an individual with a long-standing anatomical variant such as this, suddenly presents with the symptom of nasal blockage and it is important that we do not simply focus on the septum (or turbinate) but rather ask ourselves ‘Why now?’ instead of simply listing the patient for septal surgery.