Question 1

If my CT scan looks relatively normal, does that mean there is nothing structurally wrong with my breathing?

Accepted Answer

Not necessarily, and this is one of the most common misunderstandings patients bring to a first consultation. A CT scan provides extraordinarily detailed information about the bony and structural anatomy of the nasal cavity, but it is a static image taken at a single moment in time - it cannot capture dynamic problems that only become apparent during active breathing. Nasal valve collapse, for instance, occurs when the sidewall of the nose buckles inward during inhalation. At rest the valve may look perfectly adequate on imaging, but under the flow conditions of normal breathing it may be the dominant source of obstruction. Mucosal swelling driven by allergic rhinitis can also fluctuate hour by hour depending on allergen exposure, positional changes, and time of day. This is precisely why nasal endoscopy is performed alongside the CT rather than instead of it.

Question 2

Is it possible for two people with identical CT findings to have completely different levels of nasal obstruction?

Accepted Answer

Yes, and this phenomenon is well recognised in the ENT literature. Anatomical findings on CT - including the degree of septal deviation, the size of the turbinates, and the width of the sinus drainage pathways - do not always correlate closely with the severity of a patient's subjective experience of obstruction. One person may have a significantly deviated septum and barely notice any breathing difficulty, while another with a far more modest deviation finds their daily life severely impaired. Individual differences in nasal mucosal sensitivity, co-existing allergic rhinitis, non-allergic rhinitis, or a history of chronic sinusitis can all amplify the functional impact of a structural problem. This variability is one of the reasons a comprehensive assessment that includes both validated symptom scoring and objective anatomical investigation is far more informative than either approach alone.

Question 3

Can nasal obstruction on one side only mean something different from blockage affecting both sides?

Accepted Answer

It can, and the pattern of laterality is always one of the first things Dr Braham considers when taking a patient's history. Obstruction that is consistently worse on one side - particularly if it has been that way for years rather than fluctuating - tends to suggest a structural cause such as a unilateral septal deviation, a concha bullosa on the affected side, or a nasal polyp occupying one nasal passage preferentially. Obstruction that alternates from side to side is more characteristic of the normal nasal cycle. Obstruction that is equally severe on both sides at all times raises the question of bilateral turbinate hypertrophy, generalised mucosal swelling from systemic allergy, or more extensive sinonasal disease. The CT scan and nasal endoscopy together allow Dr Braham to examine both sides of the nasal cavity in detail and identify whether the anatomy explains the pattern of symptoms the patient reports.

Question 4

Why does my nasal blockage get worse when I lie down, and would that affect what the investigations find?

Accepted Answer

Positional worsening of nasal obstruction - particularly the sensation that whichever side of the nose you lie on becomes more blocked within a few minutes - has a well-understood physiological basis. When you lie on your side, venous blood pools in the dependent nasal turbinate and the mucosa swells in response. If the turbinates are already enlarged from allergic rhinitis or chronic inflammation, this pooling effect can dramatically worsen obstruction. The CT scan is taken in a fixed position and will not directly capture this dynamic behaviour, but it provides the structural baseline - the size of the turbinates at rest, the width of the nasal passages, and any co-existing septal deviation - that allows Dr Braham to assess whether the positional component is likely to be the dominant issue or whether structural surgery is also likely to be of benefit.

Question 5

Could my loss of smell be related to the same structural problem causing my nasal blockage?

Accepted Answer

In many cases, yes. The olfactory nerve fibres responsible for detecting smell are located in a very specific part of the nasal roof - the olfactory cleft, a narrow strip of tissue high in the nasal cavity adjacent to the cribriform plate. For odour molecules to reach this region, they must be carried upward through the nasal airway in a stream of inspired air. Anything that obstructs the superior nasal cavity or blocks this olfactory airstream - including nasal polyps, severe mucosal swelling, or a high septal deviation - can reduce smell significantly. CT scanning can identify structural narrowing of the olfactory cleft region and changes in the ethmoid sinuses immediately adjacent to the olfactory area. Nasal endoscopy allows direct visualisation of the olfactory cleft and can identify whether polyps or mucosal disease are present in this anatomically critical area.

Question 6

What happens if the endoscopy reveals something unexpected that was not visible on the CT scan?

Accepted Answer

This is not an uncommon scenario, and it is one of the clearest illustrations of why both investigations are performed rather than relying on imaging alone. Early or subtle nasal polyps in their formative stages may not yet show the soft-tissue density changes on CT that make polyps obvious on imaging, yet they can be clearly identified and even biopsied during endoscopy. Dynamic nasal valve collapse is essentially invisible on a static CT but can be definitively identified and quantified during the endoscopic examination using the Cottle manoeuvre. Adhesions and bands of scar tissue from previous operations may be too fine to resolve on CT but are immediately apparent through the endoscope. When an unexpected finding is identified during endoscopy at Melbourne ENT Group, Dr Braham discusses it with you immediately after the examination and incorporates it into the diagnostic and treatment planning discussion.

Question 7

If I decide not to proceed with surgery after my assessment, does the diagnostic information gathered have any ongoing value?

Accepted Answer

Absolutely. The information gathered during a comprehensive nasal airway assessment at Melbourne ENT Group belongs to the patient and has value independent of any decision about surgery. The CT images and endoscopic findings provide a detailed, documented baseline of your nasal anatomy at a specific point in time. If your symptoms change significantly over the following months or years, that baseline becomes a reference point of genuine clinical value. It allows Dr Braham - or any other clinician you may see in the future - to determine whether your anatomy has changed, whether a new finding has emerged, or whether the structural picture remains the same as when you were first assessed. Making an informed decision to defer surgery after a thorough assessment is entirely reasonable and is respected as such by the team at Melbourne ENT Group.

Tag: nose imaging

How CT Scans and Nasal Endoscopy Assess Nasal Airway Problems