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Nasal Obstruction

Nasal obstruction can occur due to anatomic abnormalities of normal structures in the nose, or inflammatory processes that lead to swelling in the nose. This page discusses anatomic causes of nasal obstruction. For inflammatory causes, please see the pages on Allergy and Sinusitis.

The most common causes of anatomic obstruction in adults are related to the shape and size of the nasal septum and turbinates, and less commonly the size of the adenoids. Adenoid size is usually more of a problem in children. Read more information on Pediatric Sinusitis.

Dr. Debnath with patient

Nasal Obstruction Symptoms     

The following are a few symptoms of nasal obstruction.

  • Breathing difficulty through the nose (may be one-sided or both sides)
  • Mouth breathing

Causes of Nasal Obstruction

The nasal septum is the wall that separates the two sides of the nose, and consists of cartilage and bone. Septal deviation, or a “crooked septum”, may cause a narrowed airway and difficulty breathing.

Hardly anyone’s septum is perfectly straight, but in the case of a severe deviation, surgery to straighten the septum may be necessary to restore the airway and improve nasal breathing.

The turbinates are normal structures in the nose which consist of bone covered by nasal lining. Most people have three turbinates on each side of their nose. They serve to humidify the air we breathe in through our noses and play a role in our ability to smell. Depending on the configuration of the bone or swelling of the lining over the bone, they may lead to nasal obstruction.

Sometimes the normally solid turbinate bones may develop an air cell within, as if it were blown up like a balloon. This is called a concha bullosa. This is not an abnormality, but a normal variant. This extra air cell, however, increases the size of the turbinate, and takes up extra room within the nose. This can also be surgically addressed by removing half of the air cell and leaving the remainder of the turbinate intact.

Enlarged adenoid tissue (tonsil-like tissue that sits at the back of the nose) is another possible cause of nasal obstruction. This is more commonly a problem in young children, but occasionally can affect adults as well.

Treatment for Nasal Obstruction

Septoplasty is considered if a deviated septum obstructs your nasal passages and causes nasal obstruction. The incision is made inside the nose. The normal lining of the nose overlying the septum is elevated and preserved and the crooked portions of the septum are removed. The lining is then laid back down and stitched in place. Care is taken to leave certain key supporting areas of cartilage and bone intact in order to avoid any sagging of the bridge or tip of the nose. If the deviation is severe enough or involves these support areas, referral to a head and neck plastic surgeon is appropriate to discuss a slightly more involved procedure. Septoplasty is an outpatient procedure. With the exception of some tenderness of the tip of the nose for a week or so, the recovery is typically easy.

Turbinate reduction is indicated when the tissue covering the turbinate bone is particularly swollen. Previously, the removal of turbinates was popular, but the usual treatment now is more minimally-invasive. There are several ways to address this, but one common and conservative method includes making a tiny incision inside the nose at the front of the tubinate, sliding an instrument under the lining, and shaving down the excess swollen tissue. The instrument is than removed and the thinned lining is allowed to heal back onto the bone. This procedure is also commonly combined with a repositioning of the bone out toward to side of the nose to allow more space in the airway. Like septoplasty, turbinate surgery is an outpatient procedure, and is associated with little discomfort afterwards. Patients undergoing this procedure may return to work the following day.

Surgical removal of the adenoids is called an adenoidectomy. This is an outpatient surgery as well. No cuts are required on the face. The adenoids are usually removed through the mouth, but can also be addressed through the nose.