Crooked septum with several spurs of bone blocking the nasal airway
Crooked septum with several spurs of bone blocking the nasal airway

Nasal obstruction is a common reason patients are referred to an otolaryngologist and can be associated with a wide variety of disease processes affecting the nose. The challenge for the physician is to correctly determine the reason for the obstruction and recommend the appropriate management. Depending on the cause this may include medical or surgical therapy or perhaps both in combination.

Obstruction occurring in combination with facial pain or pressure and discolored discharge may in fact be a symptom of a sinus infection requiring treatment addressing these structures as opposed to only the nose itself (for a complete description of sinusitis click here). Similarly, patients may have obstruction in conjunction with an itchy nose and eyes, and clear post nasal drip which may be a sign of an allergic problem (for more information on allergic rhinitis click here).

When a patient is unable to breathe through their nose this may also be a symptom of an anatomic abnormality of one or several parts of the nose. This may contribute to sinusitis, snoring and/or obstructive sleep apnea. These patients may have a deviated septum (the midline structure which separates the two sides of your nasal cavity), enlarged turbinates (mucosal lined projections in the nose that serve to warm and humidify air) or a narrow nasal valve.

Crooked septum with several spurs of bone blocking the nasal airway

 

Appearance of the septum after removal of the bone spurs.
Appearance of the septum after removal of the bone spurs.

The nasal valve which has an internal and an external component is the most important part of the nose for breathing purposes. The internal valve is the rate limiting part of the nose for airflow and is composed of the space between your septum and the midportion of the sidewalls of your nose. If this area is narrowed congenitally (from birth) or from trauma or previous nasal surgery, collapse and obstruction can result. The external nasal valve is composed of the nostrils and lower part of the nasal septum. In some patients, due to similar reasons as for internal valve problems, the nostrils will be too floppy, retracted or too narrowed leading to collapse and nasal obstruction. Lastly, the turbinates may also contribute to valve collapse and may appear inflamed, enlarged or may impact on the sidewall of the nose.
Patients with nasal valve collapse are usually diagnosed on the basis of physical examination. The examiner may attempt to pinpoint the area of collapse by watching you breathe in or by applying a cotton applicator to various parts of the nose to see if breathing can be improved by reinforcing a particular area.

Occasionally initial therapy with valve collapse are nasal steroids and other medical measures, but most often these patients will eventually require surgery. Other options to temporize or to be used in patients who are not good surgical candidates are things like breathe rite strips which serve to mechanically open the valve. Surgical therapy for nasal obstruction may include straightening the septum (septoplasty), reduction of the turbinates as well as widening and strengthening the nasal valve. In order to fix the nasal valve most often small cartilage grafts are obtained from the septum or occasionally discretely from the ear.

If you or one of your patients has issues with nasal obstruction that you think may be due to a deviated septum and or nasal valve issues please give don’t hesitate to give us a call.