Dr. Denis Grillo, Ear, Nose & Throat, 09/18/12

The nasal airway, which is the major conduit for air to get to the lungs, is sometimes blocked, and there can be a number of reasons for this.

The term “deviated nasal septum” means the midline wall of the nose, which consists of cartilage and bone and separates the left and right side, is not straight and narrow but thickened and twisted in such a manner that it blocks the airway.

This is a very common problem, and surgery is a common correction method. But sometimes patients do not do well or do not get 100 percent results after septal surgery, or simply do not have a deviated septum problem blocking their nose.

There are other anatomical sites that can be equally problematic and obstruct nasal breathing. These areas include the turbinates, which are a very necessary and important structure. There are three on the left, three on the right. They are bony structures that extend horizontally from the wall of the nose toward the midline, and they are covered with fleshy mucosa, the same slippery type of lining as on the inside of the mouth.

Usually, the lower one — called inferior turbinate — is a structure that can enlarge and block the airway and lead to chronic nasal obstruction and impair breathing. It can affect even sleep quality and aggravate patients when they have troubles, such as cold, allergies or sinus problems.

There is also a third area, called the nasal valve: a narrowing that occurs between the nostril and the back of the nose, much like an hourglass. It narrows down to one point and can sometimes be exaggerated and cause nasal obstruction by itself.

So nasal obstruction could be one of these three areas or it could be all three of them together.

Nasal obstruction is probably one of the most common complaints patients bring to the ear, nose and throat doctor. As mentioned, correction of the septum is a very common procedure and works quite well, but sometimes we incorporate correction of these other two areas to get the optimal result.

Besides serving as a pipeline for air, the nose also is an air conditioner, so to speak. It controls airflow rate, because too fast is not good and too slow or congested is not good. The right temperature and humidification are important so patients can breathe comfortably and have a normal exchange of oxygen and CO2.

Sometimes patients can compensate or correct for obstructions in these areas by using nasal strips, nasal spray and decongestant tablets, but these are only Band-Aid measures. If there is only a minor problem, they may work out quite well — but the underlying anatomical problem may need to be corrected to get significant and/or permanent results.

Correction of the septum is typically done in an outpatient setting, where the patient is sedated. Reducing the size of the turbinates in some instances can be done in the office setting, but major problems need to be fixed in a surgery center for comfort and safety reasons.

Repair or correction of the nasal valve to reduce that hourglass effect and reduce obstruction is typically done in a surgery center, and involves a removal of a small amount of tissue and cartilage and stiffening of the area so it will not collapse postoperatively. In some instances, mild disease can be tolerated and/or treated with over-the-counter measures, but for moderate to severe disease, minor surgical intervention and procedures are the way to go.

Some of the common myths and misunderstandings about nasal surgery include swelling of the eyes and the necessity to break the nasal bones with a hammer and chisel. Generally, this is not the case with these procedures — nor do patients have severe pain after these procedures or have problems with bleeding.

Sometimes immediate improvement is noted after the procedure, but in some instances there is some swelling and it takes time for the healing process and the swelling to go away to realize the result.

There are multiple options available for nasal obstruction. If you are suffering from this condition, consider having it looked at and evaluated to see if you are a candidate for any of these procedures.

Denis Grillo, D.O., FOCOO, is an ear, nose and throat specialist in Crystal River. Call him at 352-795-0011 or visit CrystalCommunityENT.com.