Otolaryngology–Head and Neck Surgery
Nasal Obstruction
If you have the feeling that your sinuses are “blocked” or “congested,” or if you’re unable to breathe through the nose overall, you may have nasal obstruction.
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Overview
This sensation may be felt on just one side of the nose, or both, sometimes alternating back and forth. There are three common explanations for this:
- Deviated Septum: The septum is in the middle of your nose and divides the left and right nostrils. Its normal position is situated right in the middle of the nose, but when it is not, it is known as a deviated septum.
- Turbinate Hypertrophy: Turbinates are structures on the inside of the nose that filter, warm, and humidify the air we breathe. The moist mucus lining of the turbinates provide water in this process. When the mucosa becomes inflamed, it can cause nasal obstruction.
- Nasal Valve Compromise: The nasal valve is the narrowest cross-sectional area of the nasal cavity and is a major determinant of nasal airflow. Nasal valve compromise is a common, yet under recognized cause of nasal obstruction.
Other medical reasons may include chronic rhinosinusitis, allergies, nasal polyps, or rarely, nasal tumors.
5Common Symptoms
- Nasal congestion or stuffiness
- Nasal blockage
- Difficulty breathing through the nose
- Trouble sleeping
- Difficulty getting enough air through the nose during exercise or exertion
Diagnosis and Treatment
A deviated septum is diagnosed by either looking up the nose with a flashlight or with an endoscopic examination. Surgery is the only way to correct a septal deviation, but it is not always recommended. Sometimes it is better to manage symptoms with nasal sprays instead, which help decrease swelling inside the nose. When symptom management is not enough, a septoplasty is recommended.
Turbinate hypertrophy is most commonly caused by allergies, but there are other inflammatory processes and medications that may cause this. If the obstruction is caused by allergies, the best treatment is to manage the inflammation with nasal steroid spray, nasal antihistamine spray, or an oral antihistamine. If it is caused by abuse of medications, often discontinuing the use of that medication will alleviate symptoms. In some cases, surgery (turbinoplasty) is recommended to reduce the size of the turbinates.
Nasal valve compromise may result from a patient’s unique nasal anatomy or from previous nasal surgery, trauma, or aging. The diagnosis of nasal valve collapse is made by examining the sidewall of the nose and looking at collapse of the nasal structures with breathing while assessing the strength of the sidewall of the lower part of the nose. For patients with nasal obstruction that cannot be corrected with medical management, a septoplasty, or turbinoplasty alone, a procedure known as a nasal valve correction (nasal valve repair), or functional rhinoplasty, may be recommended.
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