I often get asked why nasal breathing is important.  To understand, it's important to know what role the nose serves.  Besides smelling goodies and not so goodies, I like to think of the nose as a wonderful organ whose job is to prepare the air before it goes to the lungs.  It warms and humidifies the air, it filters and traps debris and germs, it adds nitric oxide which has further anti-germ activity and also allows for efficient oxygen absorption. 

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Nasal obstruction causes are many and maybe due to a deviated nasal septum, nasal valve problems, swollen turbinates, nasal polyps, enlarged adenoids, infection, allergies, and tumors.  Chronic nasal congestion can lead to chronic fatigue, dental problems, and snoring and sleep disorders.  No matter the cause, chronic congestion can often cause problems with your quality of life. 

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Anatomy of the Nose

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People are often surprised to see how large and deep the nasal cavity is.  Whether the nose is big or small on the outside, the nasal cavity extends deep into the face to the front of the ear.   Multiple problems may affect the patency of the nasal cavity.  A close inspection by an ENT specialist can find the cause of chronic congestion.

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Causes of Nasal Obstruction or Congestion

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Temporary causes for nasal congestion includes:

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• Common cold or the flu

• Allergic and non-allergic rhinitis

• Environmental irritants, such as smoke or dust

• Sinus infection

• Cold or flu

• Certain medications, (examples are some high blood pressure medicines and ED drugs like Viagra

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Chronic nasal congestion causes are often Structural-Anatomic and includes:

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• Deviated Nasal Septum (the wall separating the two nasal cavities)

• Enlarged Turbinate (bony structures on the side of the nose lined by mucosa/tissue)

• Nasal Valve Collapse or Narrowing

• Adenoid tissue enlargement

• Polyps and Tumors (majority are benign but some are cancerous)

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Chronic nasal congestion may cause

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• Fatigue

• Decrease in productivity

• Depression, irritability, mood swings

• Poor sleep quality

• Dental decay

• Negatively impacted quality of life

• Difficulty tolerating CPAP or Oral Appliance for treatment of Sleep Apnea

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Nasal Obstruction and Snoring

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Nasal congestion may also contribute to snoring.  When the nose is congested, the demand for air causes you to breathe through your mouth.  Mouth breathing causes turbulence and due to increased negative pressure behind the soft palate, fluttering occurs which can cause or worsen snoring. 

A study conducted by the University of Wisconsin Sleep and Respiratory Research Group found that nasal obstruction led to increased sleep disordered breathing events, such as snoring and apneas. Study participants with nighttime congestion reported more:

• Habitual snoring

• Excessive daytime sleepiness

• Chronic non-restorative sleep

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If you experience chronic nasal congestion and disruptive snoring, you may be at risk for obstructive sleep apnea (OSA), a potentially dangerous condition characterized by episodes of cessation or pauses in breathing due to obstruction.

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Treatment for Nasal Obstruction and Congestion

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Home and over the counter remedies that may help.

• Nasal saline mist:  Saline is a natural decongestant and can be especially helpful for dry nose sufferers when nasal crusting (aka boogers) and thickened nasal mucus is a problem.  You can do this multiple times per day. 

• Saline irrigation:  Also known as neti-pot or sinus irrigation.   You can use premixed saline or mix your own using saline packets with distilled (or boiled then cooled) water.  Think of it as a daily bath for your nose and sinuses.

• Humidifier:  Moist air helps keep nasal passages open.

• Shower before bedtime: A hot shower before bed can reduce symptoms. Breathe the steam in slowly.

• Drink plenty of water: Liquid helps keep mucous flowing.

• Avoid smoking and other irritants:  Pollution and irritants can worsen congestion.

• Sleep with the head of the bed elevated: Sleeping on your back may encourage mucous build-up and swelling inside your nose.

 

Over the counter options:

• Nasal steroid spray:  Common ones are Nasacort, Flonase, Aller-Flo (Costco version of Flonase).  They are generally quite safe to use with some precautions.  Chronic usage may cause nosebleeds, dryness, or crusting.  Point the spray to the side of the nose (away from the middle/septum) for best results.

• Oral antihistamines:  May help when affected by allergy.

• Nasal strips or nasal cones/dilators:  Can help but often hampered by skin/nasal irritation especially with long term use.

• Decongestant Spray:  Common brand name is Arin, there are many others.  If the ingredient list shows oxymetazoline or phenylephrine, it's a decongestant spray.  Although very effective and satisfying to use because of their fast action and strong decongestant qualities, they are addictive and frequently cause a condition called Rhinitis Medicamentosa.  Usage should be very limited and short term. 

 

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Nasal Procedures and Surgeries

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Nasal obstruction is often due to an anatomic problem and when `Qtreatments are not satisfying in alleviating symptoms, a procedural or surgical treatment may be warranted.  The site(s) of the restriction is determined after a thorough evaluation to arrive at a recommended procedure. The procedure maybe done in the Office (Office) under local anesthesia, or in the Operating Room (OR) under general anesthesia. 

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• Septoplasty:  Surgery to straighten a crooked nasal septum.  Procedure is done in the OR

• Turbinate Reduction:  Procedure maybe performed in the office or in the OR.

• Functional Rhinoplasty and Nasal Valve Repair:  External structures of the nose are repaired to allow proper airflow into the nasal passages.  Typically performed in the OR.

• Sinus Surgery:  Surgery to open up blocked sinus passages.  Procedure is typically performed in the OR, some situations may allow for Office treatment with balloon sinuplasty method. 

• Polypectomy: Surgery to remove polyps if present.  Typically done in the OR, mild cases may allow for Office treatment.

• Adenoidectomy:  Surgery to remove enlarged adenoids.  Enlargement is common in kids, uncommon in adults.  Performed in the OR.           

                         

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