Nasal Airway Obstruction

Anatomy nasal turbinatesNasal airway obstructions block the nasal passages and prevent a normal, comfortable amount of air from passing through the nose. Any obstruction in the nasal cavity can be a source of discomfort and can have a significant impact on daily life. Things like eating, breathing, speaking and sleeping can be difficult. A nasal obstruction can occur because of a structural abnormality in the nose or because of inflammation and swelling of the nasal passages. Chronic sinusitis as well as nasal allergens and irritants can cause nasal airway obstruction. A comprehensive clinical evalauation by Dr. Trimble will lead to appropriate treatment.  For those with recurrent sinus infections and a diagnostic CT scan of the sinuses, in-office turbinate reduction can be very effective.  Read about the different causes of nasal obstruction:

  1. Nasal (Luminal) Valve Obstruction
  2. Nasal Septum Deviation
  3. Nasal Polyps
  4. Adenoid and Tonsil Hypertrophy
  5. Nasal Airway Anatomy
  6. Nasal Turbinate Hypertrophy - In-office treatment is radiofrequency volumetric tissue reduction (RFVTR, Somnoplasty). It is considered medically necessary for treatment of chronic nasal obstruction due to mucosal hypertrophy of the inferior turbinates.

Symptoms of Nasal Obstructions:

  • Difficulty breathing through one or both sides of the nose: Depending on the source and the location of the obstruction, it can be difficult for air to pass through the nasal passages.
  • Nasal congestion: Congestion causes difficulty breathing through the nose and a feeling of fullness.  For many people, this is worse at night.
  • Mouth breathing: When a nasal obstruction is present, it is common to unconsciously breath through the mouth instead of the nose.
  • Sleep apnea and snoring: Obstructive sleep apnea is a disorder that causes breathing interruptions during sleep and can lead to snoring.
  • Fatigue: Often a feeling of fatigue or lack of energy is due to an inability to sleep or rest well because of a nasal obstruction.

Types of Nasal Obstructions

An obstruction in the nose may be caused by a number of different conditions:

  • Rhinosinusitis: This is the most common cause of nasal obstruction. Both allergic rhinitis and non-allergic rhinitis cause swelling and inflammation that blocks airflow. Often, this obstruction leads to chronic sinusitis.
  • Nasal foreign body (NFB): NFBs are most commonly seen in children 6 months to 5 years of age. An object inserted in to the nose can block airflow and drainage. If left untreated, sinusitis and other serious problems can occur.
  • Nasal valve obstruction: The nasal valve is located between the sidewall and the septum of the nose. The valve naturally moves as part of the breathing process. When the valve is narrow or weak in structure, airflow is inhibited.
  • Nasal turbinate hypertrophy: The nasal turbinates are bone structures covered by a tissue lining.  Three turbinates line each side of the nasal cavity. Nasal turbinate hypertrophy refers the chronic enlargement of the turbinates. The cause of this condition is not always known, but it is often related to rhinitis and inflammation.  Turbinates naturally swell and shrink as part of the nasal cycle, but when they become excessively large, the result can be significant nasal obstruction.
  • Nasal septum deviation: The septum is the wall that separates the two sides of the nose. Rarely is it perfectly straight, but severe bends or deviations (present at birth or following a nasal fracture can cause a narrow airway that makes breathing difficult.
  • Nasal polyps: Nasal polyps are growths of inflammatory tissue in the nasal cavity and sinuses. They can block airflow through the nose as well as drainage from the sinuses. People with allergies or asthma are more likely to have nasal polyps.
  • Enlarged Adenoids: Adenoid tissue is located at the back of the nose. When enlarged, it can block the nasal airways causing complications such as sinusitis, snoring or sleep apnea. This problem generally affects young children, but adults can suffer from the condition as well.

Diagnosis of Nasal Obstruction

Diagnosis of the specific type of nasal obstruction is essential for effective treatment. An ear nose and throat (ENT) specialist will use a variety of tools to determine the type of nasal obstruction and the best treatment option.

  1. Nasal Exam: Dr. Trimble, an ENT doctor, will feel for tenderness and look into the nasal passages during a nasal exam to identify obstructions such as a septum deviation, enlarged turbinates, nasal polyps or NFBs.
  2. Imaging studies: CT (computerized tomography) scans and MRI (magnetic resonance imaging) are used to identify physical obstructions, and determine the exact location of the obstruction. Inflammation can also be seen on these images.
  3. Nasal endoscopy: Dr. Trimble will insert an endoscope through the nose allowing the ENT to see further into the nasal passages and sinuses. Narrow nasal passages, turbinate hypertrophy, nasal polyps and enlarged adenoids can be seen using an endoscope.

Nasal Obstruction Treatment

A number of treatments are available to correct, minimize or remove nasal obstructions. Treatments for nasal obstructions vary depending on the type of obstruction and the underlying cause.

Medications: Often medications like decongestants, antihistamines and steroid sprays are used as a first step in the treatment of nasal obstruction. These medications can be used to manage allergic and non-allergic rhinitis, shrink enlarged turbinates, reduce inflammation and swelling and control nasal polyps. For some, these therapies successfully manage symptoms and no other treatment is necessary.

Surgery: In some cases, surgery is the most effective treatment option. When other therapies do not produce the desired results or when structural abnormalities exist, surgery can produce life-changing improvements and significant relief of symptoms from nasal obstructions.

Surgical Treatment Options for Nasal Obstructions

Several types of surgical procedures are used to correct or remove nasal obstructions:

  • Endoscopic sinus surgery: This type of surgery is minimally invasive and can produce immediate results with very little recovery time. Using an endoscope, a surgeon can enlarge narrow nasal passages that block airflow and help the sinuses to drain properly.
  • Turbinate reduction: This procedure corrects nasal turbinate hypertrophy by reducing the size of enlarged turbinates causing an obstruction. Turbinate reduction can be done by removing some of the bone structure of the turbinate or by shrinking the tissue lining of the turbinate through a specific procedure known as coblation. Often, turbinate reduction is done in an office setting or in conjunction with sinus surgery.
  • Nasal polyp removal: Large nasal polyps that do not respond to medication can be removed surgically.  This surgery is typically done endoscopically, and most patients experience significant relief. Depending on the underlying cause, nasal polyps may return, and surgery could be needed again.
  • Adenoidectomy: The removal of the adenoids is a simple, surgical procedure. The enlarged adenoid tissue blocking airflow is removed though the mouth without any external incisions.
  • Septoplasty: Septoplasty is the surgical correction of a deviated septum and is needed when a bend of the septum prevents proper airflow through the nose. The straightening or reconstruction of the septum allows the nasal passages to open and function normally. 

If you suffer from nasal airway obstruction, contact Dr. Monty Trimble at DFWSinus.com or call 817-529-6200. He has offices in Fort Worth, Keller and soon to be Southlake, Texas.