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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. 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, which include a deviated septum, turbinate hypertrophy, and nasal valve compromise. All three are structural problems that may hinder normal breathing through the nose. Other medical reasons may include chronic rhinosinusitis, allergies, nasal polyps, or rarely, nasal tumors.

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Septal Deviation

The septum is in the middle of your nose and divides the left and right nostrils. Its front portion is cartilaginous while the back portion is bony. 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. Its normal position is situated right in the middle of the nose, but when it is not, it is known as a deviated septum.

Diagnosis

When a deviated septum prevents good airflow through the nostrils, it’s important to be examined by an ear, nose, and throat specialist. 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.

Treatment

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. A septoplasty corrects the deviated portions 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. Patients usually recover without bruising, swelling, or scars. It is typically done under general anesthesia as an outpatient surgery (meaning that you will not have to stay overnight).

Turbinate Hypertrophy

Turbinates are structures on the side wall of the inside of the nose that filter, warm, and humidify the air breathed into the nose. The moist mucus lining of the turbinates provide water in this process. When the mucosa becomes inflamed, it can cause nasal obstruction. 

Most commonly, turbinate hypertrophy is caused by allergies, but there are other inflammatory processes and medications (specifically, the overuse or abuse of topical decongestant nasal sprays) that may cause this.


Diagnosis

A diagnosis of turbinate hypertrophy is made by an ear, nose, and throat specialist upon examination.

Treatment

If the obstruction is caused by allergies, the best treatment is to manage the inflammation with nasal steroid spray, nasal antihistamine spray, or oral antihistamine 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 symptoms. 

In some cases, surgery (turbinoplasty) is recommended to reduce the size of the turbinates. This surgery can be performed in an office setting and with a local anesthetic. It can also be done in conjunction with septoplasty.

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. It may result from a patient’s unique nasal anatomy or from previous nasal surgery, trauma, or aging.


Diagnosis

The diagnosis of nasal valve collapse is made by examining the side wall of the nose, looking at collapse of the nasal structures with breathing while assessing the strength of the side wall of the lower part of the nose.

Treatment

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 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.