Having difficulty breathing through one’s nose can be anywhere from a nuisance to a significant health concern. In some situations, if the problem has been present for quite some time, the individual may not even realize that they are working harder than necessary simply to breathe- or even compensating by mouth breathing. Don’t compromise on your quality of life another day in suffering from nasal obstruction. Contact our office for your consultation.
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Since the body needs to breathe to survive if the nasal obstruction is significant the individual may rely on mouth breathing. The air passing through the mouth, in general, is not warmed and humidified as effectively as when it passes through the nose. The filtration and immune benefits of the nose may also be lost, therefore eliminating one of the first line disease-fighting mechanisms in the human body.
Finally, chronic nasal obstruction and subsequent mouth breathing can even lead to changes in the development of other structures. In young children, changes can cause abnormal development of the upper and lower jaws. If not corrected early enough, these changes can add to the chance of needing orthodontia to correct the abnormalities.
Even in adults, nasal obstruction can cause changes in the shape of the lower breathing areas such as the palate (roof of the mouth) and behind the tongue. These issues can lead to increased chances of developing snoring and sleep apnea, which has significant health and social effects.
Fortunately, nasal obstruction can commonly be successfully treated. The first step is to correctly diagnose the cause. Too often, such symptoms are simply written off as “allergies,” when in fact, there are other issues present.
Irritants-allergic or otherwise-can cause generalized swelling throughout the nasal cavity. (See Rhinitis). Treatments are generally aimed at reducing the inflammation and swelling that accompanies this irritation. In the past, this involved using medications or rinses. Newer treatments can block the response itself and give long-lasting benefits using a minimally invasive treatment.
The septum is the wall that separates the left and right sides of the nose. It is made of bone and cartilage. It can become crooked-“deviated”- with even mild trauma. This causes a blockage of nasal airflow. The blockage from a deviated septum can cause problems on both sides if the deviation is “S” shaped which is not uncommon. Treatment for this problem usually involves a simple surgery-septoplasty-that does not change the appearance of the nose and has a very short recovery time.
The turbinates are normal structures that protrude from the lateral wall of the nose. They can enlarge temporarily-for example when one has a cold-or chronically if irritated over time. The turbinates are necessary structures, therefore they should never be removed, but rather reduced in size. Medications, including certain nasal sprays, can accomplish this in milder cases. When this is not sufficient, or if the patient would rather not have to use medications chronically, minimally invasive procedures can be used to provide more permanent improvement.
The nasal valve is commonly the narrowest part of the nasal cavity. One can demonstrate the nasal valve by inhaling aggressively through their nose. The part of the nose that collapses is roughly the location of the nasal valve internally. In the past, correction or widening of this area required the use of external nasal strips (such as Breathe Rite), or surgical techniques they were complicated and could change the actual appearance of the nose. Now there is a minimally invasive, office-based procedure that can widen this breathing area and give long-lasting improvement.
Dr. Jerome Hester will begin by taking a complete history to understand the exact symptoms present, how often they occur, and what other treatments have been attempted. A complete examination will then be performed. Depending on the results of the history and physical, other tests such as a CT scan (a special X-ray that sees deeper inside the nose and sinuses) or nasal endoscopy (using a small scope to directly look at the lining of the nose) may be indicated.
Finally, once the correct diagnosis has been made, a complete outline of the treatment options will be presented with the risks and benefits of each option fully outlined.
Treatments For Nasal Obstruction
Non Invasive Treatment
- Nasal irrigations: Although nasal irrigations rarely resolve symptoms completely, they are very safe and can provide some level of improvement. There are various methods of irrigating, but the simplest and best tolerated involves the use of some type of device that will deliver the irrigant with some force. There are squeeze bottles sold specifically for this purpose as well as powered irrigating devices. Even an infant nasal bulb syringe can work-as well as a turkey baster! The solutions used can also vary. The simplest is a saline solution. These can be purchased, or they can be made at home using approximately 1 tablespoon of table salt in an 8-ounce glass of water. In certain situations, Dr. Hester may suggest adding specific medications to the solution. The technique is to lean slightly forward and place the device slightly into one nostril. Two to three gentle pumps should cleanse the nasal cavity. It is not necessary for the rinse to come out of the other nostril. By bending slightly forward, the rinsing will still be successful, but will not run down the back of one’s throat- an unnecessary and obnoxious feeling. Also, this can be done in the shower or over a sink to avoid a mess.
- Medications: Medications can include topical sprays such as steroids or antihistamines. These generally have to be used chronically or at least seasonally, and require use for a few days before seeing a benefit. Although generally very safe, there are potential side effects with prolonged use ranging from local irritation, crusting, or bleeding to increasing one’s risk of glaucoma. Systemic medications such as antihistamines and decongestants can also be used. Once again, these are safe drugs to use chronically in most situations, but Dr. Hester can review the potential risks and benefits before embarking on a treatment plan.
Minimally Invasive Treatment
- Treatment of rhinitis: Until recently the treatment for rhinitis and its subsequent influence on nasal obstruction was the use of medications. However, there are now two types of minimally invasive treatments that are aimed directly at the posterior nasal nerve which controls inflammation and drainage in the nose. The Clarifix procedure uses cryotherapy (cold therapy) while the RhinAer procedure uses radiofrequency (controlled heat energy) to reset the function of this nerve to normal. Both are safe, effective office procedures that are normally performed under local anesthesia in Dr. Hester’s and allow an immediate return to work.
- Turbinates: As was stated above, the turbinates are necessary structures and are not removed, but rather reduced in size. There are numerous methods to accomplish this from simply injecting steroids (to give more temporary relief) to using radiofrequency to provide longer-term benefit. These are performed in the office under local anesthesia and have no or minimal recovery time.
- Nasal Valve: External nasal strips are certainly a simple way to open the nasal valve. Their limitations include the cosmetic appearance and irritation of the skin under the strip. The Vivaer procedure uses radiofrequency to treat the nasal valve along its internal lining. Only local anesthesia is required and the patient can return to normal activity immediately. There is no cosmetic change either immediately after the procedure or long term.
- Correction of a Deviated Septum (Septoplasty): Using current techniques, this procedure is done through the nostril and does not result in any cosmetic or external change in the appearance or the nose-not even bruising. In addition, in many cases, Dr. Hester is able to avoid placing any “packing” in the nose at the end of surgery. Packing is usually a type of gauze or similar material placed in the nose to reduce bleeding and provide support for the septum as it heals. Unfortunately, it is typically left in place for 3-5 days and can be extremely uncomfortable. Avoiding packing by careful surgical techniques results in a much more comfortable recovery and more rapid return to normal activities- usually within a couple of days.
- Surgical Turbinate Reduction: There are times when a conservative reduction of the turbinates is not successful. This can be due to the actual size of the turbinates or in some cases the prominence of the turbinate bone which is in the center of the turbinates. In this situation, a direct reduction of the turbinate can be performed. Although this is typically done in the operating room, it does not require general anesthesia, unless the patient prefers to be asleep. Microdebridement is a technique where a small (2 mm) incision is made in the turbinate to allow placement of a device that “shaves” and removes the material inside the turbinate including the bone. Alternatively, a small amount of the turbinate can simply be removed by an incision. Both techniques preserve the functions of the turbinates and avoid the complications that can occur with complete removal such as a chronically dry, crusting nose. Dr. Hester can discuss which technique is best for you depending on your history and examination.