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Nasal Obstruction

One of the most common of all problems is that of nasal airway obstruction. We all will occasionally experience problems with a cold or allergy; however, persistent congestion is not normal and may lead to a number of associated problems.

The nose has several functions; the most important of which is "air conditioning" and initial air filtration. "Conditioning" the flow of air involves adjusting the temperature to body temperature and adjusting the humidity to close to 100%. In the absence of these nasal functions, there is a significant added element of irritation and inflammation which affects the throat, larynx and lungs. The efficiency of the nasal "air conditioning" ability is truly remarkable. Air temperature can be adjusted by as much as 100% and the humidity brought to 100% in the time of passage through the nose. In addition the nose is able to trap and filter a significant amount of larger, particulate material.

A number of problems result when the normal function of the nose is disrupted. Poor nasal airflow results in chronic mouth breathing which in turn often leads to sore throat, hoarseness, plugged or popping ears, post-nasal drainage, voice changes, and a sense of a "lump" in the throat. Individuals who snore often will have worsening of the snoring with nasal congestion. In severe cases of obstructive sleep apnea, a poor nasal airway may dramatically worsen the problem.

There are a number of possible factors that can contribute to nasal obstruction. Deviation of the nasal septum is one of the more common problems. Given its location, the nose is unfortunately in "harms way" and often is injured. Even a fall in early childhood may result in a subsequent septal deviation. The septum is the partition that divides the nasal airway into two sides. It is essentially a "sandwich" consisting of mucous membrane on both sides with cartilage or eggshell thickness bone forming the center. The central material provides a stiffening function. The septum does not significantly support the nose or substantially affect its external appearance (with some rare exception). If the septum is displaced it will narrow the airway. The patterns of displacement vary considerably from simple "c" shaped curves to a massively collapsed, "accordion-like" structure. This may result in obstruction of one or both sides and vary from mild to severe.

Other causes for obstruction include enlargement or chronic inflammation of otherwise normal tissue in the nose and possibly the presence of abnormal tissue such as polyps that become obstructive. The overuse of decongestant nasal sprays can lead to a severe inflammatory problem that leads one to continue in the use of the product essentially becoming "addicted" to the spray. Accurate assessment of these potential causes needs to be made in order to successfully relieve the problem.

Lastly, there are physiological considerations which are important. The degree of nasal obstruction is affected by the position one assumes. When lying down, the nose is at heart level and as such there is passive swelling of tissue that results secondary to an increase in the venous blood pressure at the nose level. Conversely, upon assuming an upright position, there is a natural reduction of swelling; even turning over in bed results in the "higher" nostril being more open than the "lower" one.

Treatment

The goal of treatment for nasal conditions is to address all the specific problems that are causing the obstruction. Inflammatory problems may require treatment of allergy or environmental sensitivity generally with the use of anti-inflammatory sprays. The use of potent anti-inflammatory products placed directly in the nasal lining can often be very helpful. If the degree of inflammation has led to irreversible thickening of tissue then surgical therapy may be required.

Structural problems obviously cannot be resolved with medication and require surgical management. The most common procedure is a nasal septoplasty and often an SMR of the turbinate tissue.

Septoplasty

The septoplasty procedure is simple and extremely effective in repairing the nasal obstruction due to a septal deformity. Our technique involves the use of deep sedation and local anesthesia which makes the procedure completely painless. One’s awareness is of entering the operating room and momentarily thereafter being in the recovery room. There is no discomfort whatsoever during the course of the procedure.

We work through the nostril and approach the septum via a small internal incision through the mucous membrane on one side. The mucous membrane is then gently elevated off of the underlying cartilage or thin bone revealing the areas of displacement. Next the displaced areas are rectified by removing the displaced tissue followed by replacing flat pieces back in these areas. The mucous membranes then go back together essentially like a "sandwich". We generally then place soft, silicone rubber "splints" in the nostrils to help gently support a hold the septum in a centered position. One is able to breathe through the nose immediately, and once the splint is removed in approximately 3-4 days (painlessly) the breathing is dramatically improved. We do not use any packing material of any kind. One is able to be driven home within 15-30 minutes of when we finish.

There is very little discomfort afterwards with little if any need for pain medication. There is absolutely no external change in the appearance of the nose unless a Rhinoplasty is performed at the same time. There is no bruising or swelling. Most individuals are able to return to normal activities in 3 days.

SMR of the Turbinates

The inferior turbinates of the nose are the structures that protrude into the nasal airway internally and are often responsible for congestion and also for excess mucous production. Judicious trimming of this nasal tissue is very helpful in further improvement of the airway. This procedure is often performed in conjunction with septoplasty.

The SMR is performed by careful physical trimming of the underlying thin bone of the turbinate often combined with trimming of excess soft tissue. This very simple procedure takes only a few minutes to accomplish and is highly successful.

The treatment of nasal airway obstruction can result in dramatic and extremely satisfying improvement. There is rapid recovery and the success rate approaches 100%.