Nasal Obstruction / Broken Nose
Nasal obstruction is a common problem in patients of all ages, in which there is a mechanical blockage of airflow through the nose. Nasal obstruction can contribute to many medical problems including sinus infections, nosebleeds, snoring, sleep apnea, facial growth abnormalities, dental and orthodontic problems, and can affect athletic performance and participation. Our ENT physicians have expertise in nasal disorders and will offer treatments based on the specific cause(s) identified.
Causes and Treatment of Nasal Obstruction
The cause of the obstruction may be generally divided into two primary problems: skeletal abnormalities (which are fixed) or soft tissue structure problems (which are variable). These abnormalities can exist individually, or frequently in combination with each other, exacerbating the degree of obstruction.
Fixed/skeletal abnormalities contributing to nasal obstruction are anatomic deformities inside the nose. Two common skeletal abnormalities in the nose are a deviated septum and hypertrophic turbinates. A deviated septum means that the thin wall which separates the two nasal cavities is crooked or displaced to one side. Septal deviations may be present at birth or result from injury. Since this is a skeletal problem, it does not respond to medical treatment with reliable success; it must be treated surgically. To repair a deviated septum, the ENT surgeon performs a septoplasty to straighten the septum and restore the airway. A septoplasty is done entirely through the nostrils and does not result in bruising or facial swelling. In young children who have not yet reached puberty, a septoplasty is not usually recommended because the nose is still growing and it is much more technically difficult to obtain an optimal result.
Another common skeletal abnormality contributing to nasal obstruction is bony hypertrophy of the turbinates. The turbinates are long thin bony structures of the nose, lined with mucous membranes, which filter and warm inhaled air. When the bony portion of the turbinate grows abnormally, it can protrude into the airway and obstruct airflow. The ENT surgeon performs a resection of the turbinate bones to reduce their size and obstruction of the nasal passage. This outpatient surgical procedure can be safely performed on young children with skeletal nasal obstruction due to hypertrophic turbinates, and may be combined with other procedures.
Soft Tissue Abnormalities
Variable/soft tissue causes for nasal obstruction can include swollen/congested mucosa of the turbinates, nasal polyps, or postnasal obstruction due to enlarged adenoids. When nasal obstruction is due to these type of soft tissue abnormalities, the severity of symptoms can vary significantly on a day-to-day basis. Sometimes the symptoms are well-managed simply by medical therapies, instead of surgery.
Soft tissue enlargement of turbinates could be related to inflammation, chronic infections, allergies or other non-inflammatory phenomena, such as vasomotor rhinitis. When nasal obstruction due to hypertrophic turbinates is not relieved by medications, nasal sprays, allergy shots or other non-surgical interventions, the ENT surgeon can surgically reduce the size of the turbinates which decreases airway resistance while preserving their natural function. This should improve nasal breathing and may reduce nasal drainage and post-nasal drip. This is an outpatient procedure, sometimes performed in conjunction with other sinus or airway procedures if indicated.
Nasal polyps are benign growths that develop from the lining of the nasal passages or sinuses. If large enough, these growths may block the passages and cause breathing difficulties, sinus infections, loss of sense of smell, or other complications. They often develop in association with respiratory diseases such as sinusitis and allergic rhinitis, or immunodeficiency conditions. Nasal polyps are most common in adults, especially those with asthma or allergies. Children and adults with cystic fibrosis are also at a higher risk of developing nasal polyps.
Medications in the form of pills, nasal sprays or allergy shots can sometimes reduce the size of polyps or even eliminate them. More often, however, medical treatment may not be successful and surgery may be required to remove polyps. This type of surgery is almost always performed endoscopically, and may include sinus surgery to clear away the polyps and try to resolve chronic infection. Once surgically removed or successfully treated with medications, polyps tend to recur in some patients. Continued medical treatment is often needed. More information.
Since the nose projects prominently from the middle of the face, it is the most commonly broken bone on the head. Frequently caused by sports injuries or falls, a broken nose can be very painful and significantly change the facial appearance and the ability to breathe through both nostrils. Symptoms suggestive of a broken nose may include a significant amount of pain and a nosebleed at the time of the injury, with difficulty breathing through one or both nostrils. "Black eyes" and a slightly crooked nose or bump following the injury may also indicate a fractured nose.
After an injury to the nose, it is important to see a primary care doctor or emergency room physician to check for a septal hematoma. If a septal hematoma is present, it must be treated promptly to prevent complications. If you suspect your nose may be broken, a prompt evaluation by Dr. Bryan or Dr. Mettman 4-5 days after the injury (to allow swelling to subside) is critical to determine if a fracture needs surgical repair. Prompt evaluation and treatment affect the extent and success of a nasal fracture repair.
If your nose is broken but not out of position (non-displaced fracture), you may need no further treatment. If the bones are displaced (pushed out of their normal alignment) they can be realigned under general anesthesia. If left untreated for more than 2 weeks, a displaced nasal fracture may not be able to be realigned for several months, until the fracture has completely healed to prevent complications of nasal deformity. This delayed surgical repair requires a septorhinoplasty procedure, which is a much more extensive and expensive surgery, with less predictable results.
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