Difficulty breathing through the nose is one of the most common complaints of patients that come to our clinic. Most commonly folks will describe cases of occasional and temporary difficulty with passage of air through the nose. This is usually due to inflammatory conditions such as an acute upper respiratory infection or allergy. The nasal mucosa, or lining of the nose, becomes engorged with fluid when inflamed, and will eventually block the nasal passages. Most commonly, upper respiratory infections or common colds are caused by viruses rather than bacteria, and are accompanied by other common symptoms such as sore throat, nasal drainage, headache, facial pain, cough, and other general symptoms such as body aches, fatigue, change in appetite, and fever. Allergy will often be associated with a certain time of year or environmental factor, with symptoms such as nasal drainage, itchy eyes and throat, rash and itchy sensation of the skin. Occasionally some people have nasal congestion from exposure to chemical irritants such as cleaning agents like bleach, odors such as perfumes, or for no identifiable reason. We attribute this phenomenon to nonallergic rhinitis, which may be caused from irritation to the sensory nerve in the nose, causing swelling in the nose as a response.
These temporary conditions that cause people to feel congestion and even obstruction of their nose are usually treated with anti-inflammatory medications such as antihistamines and steroids, and sometimes even require antibiotics when there are signs of true bacterial infection, such as purulent discharge. Decongestants such as nasal sprays called oxymetazoline or pseudo-ephedrine are great medications to help with nasal congestion in the acute period of a cold or allergy, but if used chronically such as more than 5-10 days, these sprays will cause rebound swelling, and worsen the nasal congestion. Often nasal saline irrigations will also help, as the solution thins mucus, dilutes environmental agents causing inflammation in the nose and sinuses, and keeps the nasal cavity moist and healthy. Occasionally people feel congested due to simple dryness of the nasal cavities and develop crusts, and saline irrigations are the simple solution to loosening the crusts and unblocking the nasal cavity.
Occasionally patients experience difficulty breathing through the nose for extended periods of time. This can sometimes be due to inflammatory conditions, such as severe year-around allergy or chronic sinusitis causing polyps that obstruct the nasal passages. The most common cause of permanent blockage of the nasal passages is an anatomic variation called a septal deviation. The septum is the cartilage dividing the two sides of the nose, and can be deviated from trauma but more commonly due to the variations of nasal growth in comparison to growth of the rest of the facial skeleton. Also, the turbinates, or ridges in the nose covered with mucosa, can be enlarged chronically, and block the nasal passages. In young children, enlarged adenoid tissue is the most common cause of chronic nasal drainage and congestion. Sometimes people can also experience nasal obstruction because of collapse of the nostrils due to one’s anatomy. All these anatomic causes of nasal obstruction can be corrected with surgical procedures, such as septoplasty (which is re-establishing a straight septum), inferior turbinate reduction (reducing the swelling of the turbinate), functional rhinoplasty (reshaping and reinforcing the bone and cartilage of the nasal structure to provide increased airway) and adenoidectomy in children, and endoscopic sinus surgery (to remove polyps and treat chronic sinusitis).
Cases when nasal obstruction can be concerning are found in both children and adults. Infants breathe primarily through the nose, and must breathe through the nose when feeding. When there is blockage of the nose, it should be treated as soon as possible to prevent respiratory distress and difficulty feeding in infants. Children commonly place foreign bodies such as beads and toys in the nose, and those must to be removed in a timely manner so they don’t get inspired into the throat or cause a perforation in the septum. In children and adults, there can be cancerous tumors that cause blockage of the nose, often accompanied by other symptoms such as nose bleeding, vision changes, numbness of the face, and facial pain. If there is persistent thin clear salty fluid leaking from the nose, particularly after sneezing or bearing down, there can be an abnormal connection between the brain vault and nasal cavity, and should be investigated.
However, nasal blockage most often is a benign problem, one that affects one’s quality of life rather than life-threatening. However, if chronic, there is evidence to support that the inability to breathe through the nose greatly contributes to lack of delivery of oxygen when sleep, causing obstructive sleep apnea. Obstructive sleep apnea can increase the chance of cardiac disease and risk of stroke. This entity is being increasingly recognized as the obesity epidemic becomes more severe. One of the most effective treatments for obstructive sleep apnea is the correction of nasal obstruction.
We would highly recommend that you be evaluated by a head and neck specialist if you experience nasal obstruction that is interfering with your quality of life. It can often be easily managed, but occasionally a simple outpatient procedure can make a real difference in your life.
Nasal obstruction can be caused by many factors including a deviated septum (the wall on the inside of your nose that separates the right and left nasal passages), inferior turbinate hypertrophy (structures within your nose that help warm and humidify the air that enters your nose), or weakened cartilage on the outside of your nose to name a few. If the septum is crooked or the inferior turbinates are large, this problem can be corrected with a septoplasty that straightens the septum or an inferior turbinate reduction. These are relatively easy procedures to perform and typically do not lead to any cosmetic deformity of the nose because the surgery is performed inside your nose.