Deviated Septum / Nasal Obstruction
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. More info.
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 combined with other endoscopic 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 a nasal obstruction is due to these types of soft tissue abnormalities, the severity of symptoms can vary significantly on a day-to-day basis. Unlike skeletal causes for nasal obstructive symptoms, soft tissue problems may sometimes be well-managed 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.