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Nasal Obstruction/Deviated Septum
Many individuals suffer from chronic difficulty breathing through the nose. This can be a bothersome problem. Chronic congestion is not only a terrible nuisance, but also can interfere with sleep, contribute to snoring or sleep apnea, and lead to mouth breathing and dental problems. Nasal obstruction can even adversely affect an individual’s athletic ability.
What causes nasal obstruction?
Contributing factors to nasal obstruction include chronic inflammation from sinusitis or allergies, which may respond to medical treatment.
The majority of individuals with nasal obstruction suffer from anatomic deformities inside the nose, the most common of which is a deviated septum. The nasal septum is the wall separating the two nostrils. Ideally, this should be straight. However, in many individuals the septum is crooked, or deviated. Sometimes this can be related to previous nasal trauma but there may be no significant history of trauma. The septum may be deviated to one side causing left or right-sided obstruction or may deviate into both nostrils.
Turbinate enlargement can also contribute to nasal obstruction. Turbinates are the folds of tissue arising from the outside nasal wall on each side that project into the nostril. The turbinates help to warm and humidify the air we breathe. The lowest turbinate on each side is in the airflow path. Turbinates are composed of tissue that swells and shrinks in response to a variety of stimuli, leading to a variable component of nasal obstruction. Normal behavior of the nose includes a nasal cycle in which the turbinates will swell on one side and shrink on the other causing nasal obstruction to be worse on one side or the other. Several hours later this reverses and the obstruction may switch sides. Turbinates become more engorged when we lie down and congestion may become worse.
How is nasal obstruction treated?
The good news is that there are excellent ways to treat nasal obstruction. If medical treatment does not alleviate the obstruction and a physical blockage is identified, surgery may be recommended. The most common surgery is a septoplasty, which involves straightening the nasal septum. Turbinate reduction may also be recommended.
How the surgery works: Surgery is performed in the operating room, usually under a general anesthetic. The surgery lasts about an hour and the patient goes home about an hour later. Typical recovery includes some discomfort, which is controlled with medication. There may be some oozing of blood from the nose for the first day or so, which can be collected by a gauze drip pad under the nose. There may be some splints inside the nose on either side of the septum for a few days to a week. Patients should expect some nasal congestion during the initial recovery.
Surgery is usually well tolerated and most patients experience significant improvement in symptoms. Potential risks include but are not limited to infection, bleeding, persistent nasal obstruction, and septal perforation.
Will this change the appearance of my nose?
There is generally no outward change in the appearance of the nose with this surgery. If an individual is interested in altering the appearance of the nose at the same time as improving breathing, this can be accomplished with simultaneous rhinoplasty surgery. The best time to change the external appearance of the nose is in conjunction with septoplasty. Reasons for this include the fact that the individual has to undergo only one surgery, one anesthetic and one recovery instead of two, and the combined surgery may be more cost effective than doing the two separately. The most important reason for performing the two surgeries at the same time is that rhinoplasty frequently requires cartilage grafts from the septum to strengthen the nose or to obtain the appropriate shape. If you have already had septoplasty surgery and require a cartilage graft for rhinoplasty there may not be adequate cartilage left in the septum. In this case, the surgeon may need to harvest cartilage from the bowl of the ear or from a rib.
Septoplasty surgery is frequently combined with sinus surgery to treat chronic sinusitis or throat surgery to treat obstructive sleep apnea.
By Kent G. Davis, MD