Treatments: Nasal Air Flow
This section elaborates on specific treatments for improving breathing problems from the nostrils to the windpipe. Smell function requires some airflow from the nostrils to a small area high in the nose.
medical approaches to nasal breathing
Medical (non-surgical) efforts may improve the nasal airway adequately. Therefore, before surgery is considered, and sometimes to supplement the surgical result, the best medical management of sinus infections involves utilizing individualized medicines addressing inflammation, allergies, pollutants (including all forms of smoke), reflux, and specific causes of infection. These insults to the lining of the nasal surface cause it to swell, thus narrowing the airspace.
Several different types of nasal sprays or rinses exist and are not necessarily interchangeable. For example, nasal steroid sprays reduce inflammation, whereas antihistamine pills or sprays (e.g., azelastine spray) reduce histamine production and the associated swelling. Cromolyn reduces histamine release by another mechanism. Nasal saline (salt water) mist or rinse is a drug-free way to clean the nose. Combinations of different nasal spray types, oral medications, or allergy treatments may result in an adequate nasal airway. If a nose is addicted to decongestant sprays or drops (such as Afrin (oxymetazoline), Sinex or Neosynephrine (phenylephrine), a condition called “rhinitis medicamentosa,” the necessary treatment is stopping use of those decongestants.
Avoiding exposure to environmental allergens may significantly help the nasal airway among allergic individuals. Allergy testing may be useful in determing whether if an individual has an allergic response to specific common airborne particles. Avoiding smoke exposure is very helpful, and achieving good nasal airflow in an ongoing smoker is difficult.
A normal septum (left image) versus a deviated nasal septum (right image).
septoplasty
Straightening the septum is performed to improve nasal airflow, unblock a sinus, and in cases where a point of contact between the septum and the lining of the nose, septoplasty can resolve a source of facial sinus pain.
turbinate reduction
The turbinates are anatomic structures that project into the nasal airspace from the left and the right. The nasal airway is the space between the turbinates and the septum. The inferior turbinate, which runs along the route of airflow low in the nose, may be enlarged and therefore account for nasal airway resistance. If medical approaches to reduce the swelling of the turbinates fails to achieve adequate improvement, function-sparing procedures such as sub-mucous partial turbinate resection or radiofrequency ablation of excess turbinate soft tissue are powerful techniques that may be employed to achieve an improved nasal airway.
nasal valve
The nasal valve area is the nostrils (external nasal valve) and just a little further back (internal nasal valve) where the sidewall of the nose and the septum are narrow and sometimes get narrower with inspiration. Especially for people with European ancestry, this area accounts for up to 90% of the airflow resistance from the tip of the nose to the lungs! When placed properly (low on the nose, just above the nostrils), Breathe-Right strips may help with nasal valve narrowing. Experiencing improvement with Breathe-Right strips is useful information for your surgeon, as this product simulates the benefit from certain surgical techniques that may be used to help this problem.
septal perforation
When the septum (the wall dividing the left from the right side of the nose) has a hole in it (perforation), crusts build up, the septum swells, and nosebleeds occur. All of these impair the nasal airway. Here are some options for treating this vexing problem:
Frequent saline rinses
Placement of a nasal septal button
Surgical closure of the perforation. Here is an animated video demonstrating this procedure.
sinus infections
Sinus infections impair breathing, and sometimes a stuffy nose is the only clue that one has a sinus infection. Nasal polyps, which are often associated with a sinus infection, also block the airway and are usually associated with sinus infection as well.
Nasal breathing and CPAP for OSA
Surgical improvement of the nasal airway in patients with obstructive sleep apnea may reduce the pressure setting required by CPAP (Continuous Positive Airway Pressure). While nasal surgery alone does not cure OSA (Obstructive Sleep Apnea), the lowered CPAP pressure requirements tend to make CPAP more tolerable.
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