The nose is the entry to airway, and can allow either unrestricted air flow or be the first source of obstruction. When the nose is the source of airflow obstruction, instituting medications or having a simple surgery may result in total resolution of airway symptoms.
The major potential sources of nasal obstruction are:
- The nasal septum
- The inferior turbinate
The nasal septum is the midline nasal divider, separating the nose into left and right sides. It may be straight, slightly deviated (shifted to one side) or significantly deviated, resulting in nasal obstruction on that side.
The nose naturally cycles, allowing breath to pass primarily through one side for a period of time (around 6 hours) and then the other side. This allows each side to “rest” and recover from the drying effects of the air. However, in those who have a deviated septum, when the nose cycles to the obstructed side, breathing becomes difficult. At night, this may cause mouth breathing, which may cause snoring or sleep apnea. Treating a deviated septum may result in resolution of sleep symptoms.
The inferior turbinate is a cylindrical structure that runs from the front of the nose to the back. It serves to moisturize, filter, and warm the inhaled air. As the initial contact point between the outside air and the body, the turbinate will react the most vigorously to external irritants. Turbinates become swollen with pollution, allergens, viruses, and other inhaled irritants. When they swell, the inferior turbinate may cause significant nasal obstruction. At night, the turbinates naturally swell more, which will worsen symptoms.
This may lead to mouth breathing, snoring, and sleep apnea, as well. Treatment of the turbinates may involve a nasal spray, rinse, or a simple procedure aimed at reducing turbinate size.
Treatment of nasal disease can dramatically improve quality of life. For those patients using CPAP for their sleep apnea, nasal surgery will improve the comfort of the device. In some patients, it eliminates the need for CPAP altogether. Quality of life during the daytime also improves, as nasal breathing (instead of mouth breathing) results in healthier air intake, decreasing the likelihood of respiratory illnesses.
These simple disease processes are easily treated. However, at times nasal disease can be much more serious, requiring advanced treatment protocols to result in resolution. For example, a septal perforation can cause significant airway symptoms, and treatment of this difficult problem is extremely complex. Prior rhinoplasty may result in functional breathing problems from collapse of the nasal airway. These more difficult problems require treatment from a nasal surgical specialist with extensive experience in these infrequently performed surgeries.