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Nasal obstruction is blockage of the nose or nasal cavity. It can have many causes and can range from a mild annoyance to a serious condition. One common cause is a deviated nasal septum. The septum is the structure separating the nostrils inside the nose. Septal deviation, or a "crooked septum", may cause a narrowed airway and difficulty breathing. If severe then surgery may be necessary to straighten the septum and restore the airway and improve nasal breathing. Another common cause of nasal obstruction is called inferior turbinate hypertrophy. On the inside of the nose there are normal bony structures called turbinates. Most people have three turbinates on each side of their nose. They serve to humidify the air we breathe in through our noses and play a role in our ability to smell. They are covered by a large amount of spongy mucosa (the pink lining inside the nose). The turbinates are very susceptible to allergy and dust irritation. If they become swollen, it can be difficult to breathe through the nose. Enlarged adenoid tissue (tonsil-like tissue that sits at the back of the nose) is another possible cause of nasal obstruction. This is more commonly a problem in young children, but occasionally can affect adults as well.
Mouth breathing is common in individuals whose nasal passages are obstructed or restricted. It is an involuntary, subconscious adaptation simply in order to get enough air. Long term mouth breathing in children may affect their teeth and appearance of their face. It also may cause gingivitis (inflamed gums) and halitosis (bad breath), especially if mouth breathing occurs during sleep.
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You will be asked to give a complete medical history and your doctor will perform a thorough physical examination. This will involve nasal examination with lighted scopes and may use imaging, including CT scans and MRIs, when necessary. Your doctor may also recommend testing for allergies.
Treatment of nasal obstruction usually begins with medication to address any underlying allergies or reversible causes of nasal swelling. Your doctor may also recommend additional conservative treatments such as avoiding known allergens and using nasal saline irrigations. Common medications used to treat the various causes of nasal congestion include:
If there is no improvement with medications surgery may be required.
Depending on the cause of the nasal obstruction the most common surgeries are to correct a deviated septum (septoplasty) or to shrink the turbinates.
Septoplasty is considered if a deviated septum obstructs your nasal passages and causes nasal obstruction. The incision is made inside the nose. The normal lining of the nose overlying the septum is elevated and preserved and the crooked portions of the septum are removed. The lining is then laid back down and stitched in place. Care is taken to leave certain key supporting areas of cartilage and bone intact in order to avoid any sagging of the bridge or tip of the nose. If the deviation is severe enough or involves these support areas, referral to a head and neck plastic surgeon is appropriate to discuss a slightly more involved procedure. Septoplasty is an outpatient procedure. With the exception of some tenderness of the tip of the nose for a week or so, the recovery is typically easy.
Turbinate reduction is indicated when the tissue covering the turbinate bone is particularly swollen. Previously, the removal of turbinates was popular, but there are several new surgical techniques that can be used to shrink turbinates, including use of radiofrequency energy or a small tissue-shaving device. One common and conservative method includes making a tiny incision inside the nose at the front of the tubinate, sliding an instrument under the lining, and shaving down the excess swollen tissue. The instrument is than removed and the thinned lining is allowed to heal back onto the bone. This procedure is also commonly combined with a repositioning of the bone out toward to side of the nose to allow more space in the airway. Like septoplasty, turbinate surgery is an outpatient procedure, and is associated with little discomfort afterwards
Your doctor may recommend having your adenoids removed surgically if they are the cause of the nasal obstruction. Most adenoidectomies are performed on an outpatient basis.
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