ESR Essentials: imaging in nasal obstruction and epistaxis—practice recommendations by the European Society of Head and Neck Radiology

Nasal obstruction and epistaxis are common otorhinolaryngologic complaints with multiple etiologies ranging from benign anatomical variations and mucosal inflammation to severe neoplastic and vascular disorders. Clinical evaluation and nasal endoscopy are first-line diagnostic tools, with imaging reserved for selected indications. Imaging differentiates uncomplicated from complicated presentations, guiding management and surgical planning. Computed tomography (CT) is the primary modality for assessing sinonasal anatomical variants, bony pathology, and inflammatory or neoplastic disease. Magnetic resonance imaging (MRI) complements CT when soft tissue or intracranial extension is suspected. Imaging in epistaxis is not routinely indicated but is recommended in recurrent, severe, or posterior bleeding to detect underlying vascular lesions or tumors. CT angiography is preferred for vascular assessment and interventional planning. Implementing these recommendations can improve diagnostic accuracy, streamline patient management, and enhance surgical outcomes in patients presenting with nasal obstruction and epistaxis. KEY POINTS: Clinical history and nasal endoscopy should be the primary tools for initial assessment, with imaging reserved for inconclusive or persistent cases. CT is the preferred imaging modality for evaluating structural causes of nasal obstruction, especially prior to surgical intervention. Imaging in epistaxis is indicated mainly in severe, recurrent, or posterior bleeding to localize the source and guide treatment.