Sometimes patients come into the Sinus Center because they feel “blocked” or “congested” – unable to breathe through the nose. This sensation may be felt on just one side of the nose, or both, or sometimes alternating back and forth between both sides. There can be many different explanations for this condition—nasal obstruction—which is why it’s important to see an ear, nose, and throat doctor if you are experiencing these symptoms.
Three common explanations for patients experiencing nasal obstruction are deviated septum, turbinate obstruction and nasal valve compromise. All three are structural problems that may hinder normal breathing through the nose.
In addition to these structural reasons that cause nasal obstruction, there are medical reasons. These include chronic rhinosinusitis, allergies, and rarely, nasal polyps or nasal tumors.
Metson, Ralph; Mardon, Steven, The Harvard Medical School Guide to Healing Your Sinuses, McGraw-Hill Professional, Figure 18.1 pg. 160
The septum is the bone and cartilage in the middle of your nose, dividing the left from the right. The front part of the septum is what you see between your nostrils, but the septum is actually very long and extends far back into the nose. It should be situated right in the middle of the nose. If it is not in the middle, it is called “deviated septum.” This condition is very common, and it only becomes a concern when it causes nasal obstruction.
When septal deviation prevents good airflow through the nostrils, it’s important to be examined by an ear, nose, and throat doctor. Septal deviation is diagnosed by either looking up the nose with a flashlight, or by an endoscopic examination. An endoscope allows the physician to look through the entire nasal cavity, which extends far beyond what you can see through the front of the nose, with a small telescope.
Metson, Ralph; Mardon, Steven, The Harvard Medical School Guide to Healing Your Sinuses, McGraw-Hill Professional, Figure 4.2, pg. 42.
Surgery is the only way to correct a septal deviation, but it is not always recommended. Sometimes it is better to instead manage the symptoms of nasal obstruction with nasal sprays to try to decrease the swelling inside the nose.
In some cases, managing the symptoms is not enough, and a “septoplasty” surgery is recommended. The goal of septoplasty is to straighten out the bone and cartilage of the nose so that the septum becomes straighter, allowing better airflow through each nostril. The surgery is minimally invasive, as it is done through the inside of the nose without any external incisions. Usually the patient recovers without bruising, swelling, or scars. It is done under general anesthesia as an outpatient surgery (meaning that you will not have to stay overnight).
Turbinate obstruction essentially means “big turbinates.” Turbinates are structures inside the nose that make up the outer edges of the nostrils, situated opposite the septum in the middle of the nose. They are composed of a layer of bone and are covered by mucosa, the lining of the nose.
Metson, Ralph; Mardon, Steven, The Harvard Medical School Guide to Healing Your Sinuses, McGraw-Hill Professional, figure 2.2 Inside the Nose, pg. 14.
The normal function of turbinates is to warm and humidify the air breathed into the nose, so that it does not irritate the lungs. The moist mucus lining of the turbinates provide water in this process. This is an important part of the respiratory system; and therefore, the turbinates cannot simply be removed without potential complications.
The mucosa of the turbinates can become inflamed for a variety of reasons, causing nasal obstruction. The inflammation can alternate on both sides at varying times of day, meaning that the nasal obstruction may come and go on each side of the nose. Most commonly, turbinate obstruction is caused by allergies, but there are other inflammatory processes and medications (specifically, the overuse or abuse of nasal sprays) that may cause turbinate obstruction.
A diagnosis of turbinate obstruction is made by an ear, nose, and throat doctor upon examination.
If the obstruction is caused by allergies, often the best treatment is to manage the inflammation with nasal steroid spray or topical antihistamines to reduce the size of the enlarged turbinates. If it is caused by abuse of medications, often discontinuing the use of that medication will alleviate turbinate obstruction symptoms.
In some cases, surgery is recommended to reduce the size of the turbinates. The goal of turbinate surgery is to shrink the turbinates to open up the nostrils and attain better airflow through the nasal passages. This surgery can be performed in an office setting and with a local anesthetic. It can also be done in conjunction with septoplasty (septal deviation surgery).
Nasal valve compromise is a common yet under-recognized cause of nasal obstruction, which may result from a patient’s unique nasal anatomy or from previous nasal surgery, trauma or aging. For patients with nasal obstruction that cannot be corrected with medical management, a septoplasty, or a turbinoplasty alone, a procedure known as a nasal valve correction (nasal valve repair) or functional rhinoplasty may help them to breathe better through their nose. This procedure is frequently performed at the same time as the septoplasty. Together, these procedures can both straighten the septum, if needed, and open up the nasal passage.
For more information on nasal obstruction, please speak with your physician.