Conditions: Breathing: Nasal Air Flow
Several conditions, either alone or in combination, may contribute to decreased nasal airflow. Here is a video demonstrating common causes of this problem. In addition to passing air from the nostrils to the throat for breathing, a small amount of air normally makes its way to a small patch high in the nose where nerves for smell (olfaction) exist.
deviated nasal septum
The nasal septum is the wall that divides the left side of the nose from the right. When it is swollen or bent away from midline, nasal breathing is more difficult as airflow meets greater resistance on the narrowed side.
Allergies
Allergy to various particles in our environment is like an over-reaction of the immune system. Normally, inflammation occurs for good reason, such as to fight off a virus or bacteria. But with allergy, the body mounts an immune reaction, like unleashing its powerful weapons, against a target that is not a threat to the body at all. The eyes and the airway tend to be most affected by airborne particles in susceptible individuals, and the consequences can range from mild annoyance to more severe issues like breathing difficulty or making conditions favorable for a bacterial infection.
enlarged turbinates (“turbinate hypertrophy”)
Within the nose, on each side, we have outcroppings of tissue called turbinates. Their job is to warm and humidify the air we breathe before it passes to the lungs. Turbinates can be too large at times, and by taking up too much room within the nose, make breathing difficult. Enlarged (hypertrophied) turbinates may be the result of an individual's growth (that is, largely genetic), or the turbinates may be swollen due to inflammation caused by allergy or other airborne irritant.
Internal nasal valve collapse during inspiration
nasal valve collapse
The nasal valve is the collapsible part of the nose, in front of the nasal bones. The nostrils make up the external nasal valve and a little further back, between the nostrils and the bony part of the nose, is the internal nasal valve. Narrow noses or noses with more bendable cartilage tend to have a narrowing of the nasal valve when breathing in. This makes the air passage smaller, and airflow is lessened.
nasal polyps
Nasal polyp
Nasal polyps are a special case in which inflammation and swelling in the lining of the nose is extreme and soft, grape-like swellings of the lining develop. These are called inflammatory nasal polyps. Usually, polyp formation occurs gradually on both sides of the nose, causing airway blockage, reducing the sense of smell, and often making conditions favorable for a bacterial sinus infection.
Frequently, but not always, polyps are associated with an underlying inflammatory or allergic condition. Uncommonly, polyps are a sign of another medical condition (for example, cystic fibrosis in a child).
Nasal polyps
sinusitis
The nasal sinuses are spaces like caves that branch out from the nasal passageway. Infection or inflammation of these sinuses is called sinusitis (rhinosinusitis). Sounds simple, but one individual's symptoms of sinusitis often differ from another's. And many symptoms that suggest sinusitis may also be caused by other conditions, such as migraine, trigeminal neuralgia, and atypical facial pain, to name a few. Of course, a correct diagnosis is the start to effective treatment. Office evaluation for sinusitis begins with understanding a person's history, performing a physical exam, and often looking in the nose with a flexible scope and/or obtaining a CT scan of the sinuses when a complication or alternative diagnosis is suspected.
Adenoids (adenoid hypertrophy)
Adenoid tissue is like tonsil tissue, but the location is where the back of the nose meets the top of the throat. When the adenoids are very large, which is much more common in children and young adults, the adenoids may block the air passage from the nose to the throat, obligating an individual to breathe through the mouth. The position of the adenoids is in-between the Eustachian tube openings, so large or infected adenoids may impair normal Eustachian tube function (ear clearing/pressure equalization). Since the adenoids do not have a capsule (or distinct boundary) around them, removal of adenoids is more of an adenoid reduction, and in some cases the remaining adenoid tissue will re-grow.
Nasal or Sinus tumors
Although much less common than the above conditions as a cause of blockage of the nasal passageway, persistent nasal blockage on one side of the nose, unrelenting progression over weeks to months, pain, bleeding (nosebleeds), tearing from the eye on that side, or new facial numbness are some hints that may suggest the presence of a tumor in the nose or sinuses.
Rhinitis medicamentosa (addiction to decongestant spray)
Decongestant nasal sprays, such as oxymetazoline (Afrin) and phenylephrine (Neo-Synephrine), are medicines purchased over-the-counter and are applied to the nose lining. They induce intense constriction of the blood vessels within the nose and this temporarily shrinks the thickness of the nasal lining. The space available for airflow within the nose increases and breathing is easy! Oxymetazoline can last up to ten to twelve hours, while phenylephrine is much shorter-acting; either way, when it wears off, a rebound occurs in which the blood vessels and lining of the nose swell, causing a significant decrease in airflow. That is when many people are tempted to re-apply the nasal decongestant. Product labels warn against using these sprays for more than three days for this reason.
The problem for many arises from a gradual process in which the magnitude and duration of the effect of the decongestant lessens with each repeated use, while the rebound phenomenon persists. Unwittingly, a person may develop a habit of using the decongestant that is difficult to break, because after regular repeated use, people describe being completely unable to breathe through their nose unless they use their decongestant, though at that stage, the effect is brief and partial. This addiction or habituation to nasal decongestants is called rhinitis medicamentosa.
Of note, different categories of nasal sprays, such as nasal steroids, nasal saline, nasal antihistamines, etc. do not have this effect. Take note of the name on the bottle, as many generic or store brand labels say something like "nasal relief spray," with the generic name oxymetazoline or phenylephrine listed within parentheses following the trade name.
Make the most of your nasal air flow appointment.
Appointment time is valuable. Here are some suggestions to make the most of your appointment. This preparation will help you and your doctor maximize efficiency and accuracy, freeing up time for questions and answers.
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