By Marcie Lyons MS, RN, CNOR
Having trouble breathing through your nose? There could be many reasons for this, from facial trauma with structural damage, seasonal allergies causing inflammation, or a congenital anomaly that was never properly diagnosed or addressed. Primary care physicians may see the benefit of referring patients to an Ear, Nose and Throat (ENT) doctor that specializes in treating disorders of the nose and upper airway if initial treatments for basic breathing issues won’t resolve them. Along with patient reported symptoms, a look into the nose with a small camera, or endoscope, will give the doctor a better understanding of the patient’s anatomy and where to go from there. Initially, medications to treat inflammation such as decongestants, antibiotics, steroids, antihistamines, or NSAIDs may be prescribed. If the inflammation doesn’t subside, and the structure of the nose and sinuses are in question, a CT scan will be ordered for a more detailed image of the sinuses, to make a more thorough diagnosis and treatment plan.
If structural issues of the nose are detected, the patient will become a surgical candidate to correct the defect. The most common types of nasal surgery to correct structure include septoplasty, rhinoplasty, and turbinate reduction.
Septoplasty
The septum of the nose is the structure that separates each nostril, creating a left and right nostril and entrance into the sinus cavity. The septum is made up of cartilage and bone. When it is crooked, or deviated, it can obstruct the flow of air, impeding the ease of breathing through the nose. Most often, the surgical correction can be made through the openings of the nostril. If the necessary changes require a more invasive approach, the surgeon will make a small incision at the area between the nostrils, pull back the nose skin, and the cartilage and bone will be reshaped along the bridge of the nose. If extra cartilage is necessary to fix the deviation, they can retrieve some from the deeper parts of the septum, or they’ll take small piece from an ear. Temporary stents or packing may be placed for 10-14days to allow the septum to start to heal in place.
Rhinoplasty
While many people choose to have a rhinoplasty procedure, or ‘nose job,” for cosmetic reasons, others need to repair a broken nose or fix a breathing issue. Rhinoplasty can address the issues of size or symmetry of the nostrils, facial balance, bulbous or crooked tip, deviated septum, or functional breathing issues. The surgeon will lift the skin from the underlying structure of the nose, to expose the cartilage and bone. Once the cartilage and bone are rearranged and trimmed where needed, the structures are sutured into place, and the skin is returned. An internal and external splint is placed to hold the new shape of the nose and will stay in place for about two weeks. Initial swelling will subside over the first 3-6 weeks, and then more considerably over the first 3 months. Full healing and the reduction of swelling can take up to a year.
Nasal Turbinate Reduction
Nasal turbinates are boney structures that create a pathway for air to be warmed and humidified as air enters the nose. If they are enlarged, they can block the flow of air. The turbinates can be swollen from seasonal allergies, inflammation from illness, or other irritants. If antihistamines or other medications aren't helpful to symptoms, surgical intervention can be necessary. The turbinates can be trimmed or made smaller by different modalities, including excision, types of cautery to shrink the tissue, forms of low-temperature radio-frequency that reduce inflammation and calm nerves in the area that trigger a runny nose. There is little to no downtime necessary to fort his procedure and often no dressings needed.
There are more in-depth sinus surgeries that address a wider range of issues. Talk with your doctor if you are experiencing issues with breathing through your nose!
Sources:
Mayo Clinic. Septoplasty - Mayo Clinic Assessed and Endorsed by the MedReport Medical Review Board