I Can’t Breathe Through My Nose

By Ron Shashy, MD
Ear, Nose & Throat Specialists, PLLC

Nasal obstruction is one of the most common complaints in an Ear, Nose, and Throat  doctor’s office.  It seriously affects a patient’s quality of life.  Poor nasal airflow is frequently associated with fatigue, poor sense of smell or taste, sleep problems, and sinus complaints. Patients report poor airflow through either side of the nose.  The causes are multiple.

Lexington (and its surrounding area) has been ranked #1 in the country for allergy sufferers.  Allergies can show up at any age.  There is a significant genetic component, so allergy sufferers often report parents and siblings with similar symptoms.  Common complaints are nasal stuffiness, frequent sinus infections, sneezing, runny nose or post-nasal drip, itchy eyes or scratchy throat, or bags under the eyes.

Diagnosis is quite simple. An arm scratch test is very sensitive and will identify 90-95% or more of allergy sufferers.  I often see patients incompletely treated for allergies because their allergies have not been identified. Avoidance is the best strategy.  But avoidance is difficult when the culprit is unknown. As another example, I find patients on many allergy medications who have no allergies at all!  That’s a lot of wasted money.  Bottom line:  Find out if you have allergies AND what they are.

Allergy treatment has three potential components:
  • Avoid what you are allergic to.  Sounds simple! (Don’t be around cats if you’re allergic to them!)
  • Medications. These include that long laundry-list of nasal steroid sprays – Nasonex, Flonase, Rhinocort; anti-histamines – Allegra, Alavert, Zyrtec, Claritin, Loratadine; non-prescription salt-water rinses, and certain other prescription medications like Singulair.
  • Allergy shots.  These work to reduce symptoms in 70 to 80% of patients.   Up-to-date allergists also offer allergy drops (not shots) that can be given under the tongue.  This allows patients to dose themselves weekly at home and avoid trips to the doctor’s office.
Another common cause of nasal obstruction is chronic sinusitis. The sinuses are above your eyes (frontal sinuses), below your eyes (maxillary sinuses), and between your eyes (ethmoid sinuses). They sometimes seem to have no other function than to cause us problems. They are frequently treated with some of the same methods as allergies.  In addition, multiple antibiotics are often prescribed.

These may resolve symptoms, however, some patients appear to have frequent, repeated infections.  Such patients may benefit from sinus surgery, an outpatient treatment designed to expand the sinus openings.  Normally, the sinus openings are slit-like.  It’s akin to door being pulled almost closed.  The surgery acts to open things up by taking the door off the hinges and removing it.  This is a common procedure with new innovative technology aimed to improve safety and accuracy. It’s like having GPS for your nose.  Georgetown Community Hospital has this new CT image computer guidance system for improved accuracy.

A final common cause of nasal obstruction is a plumbing problem – i.e. your nose is blocked on the inside.  This could be a crooked or deviated septum.  (The septum is the cartilage dividing the nose into right and left)  Another cause is large turbinates.  These are the normal anatomy (they look like small hotdogs in the nose), which warm and humidify the air before it goes into the lungs.  Sometimes these turbinates get too big due to irritation, allergies, or sinus infections, resulting in blocked airflow. 

Polyps in the nose also may block air passage.   In general, these plumbing problems are treated medically with sprays and rinses.  But sometimes they are best treated with routine outpatient surgery to best improve the patient’s airflow.

Nasal obstruction can have many causes and thus many solutions.  The best solution is a simple non-surgical approach aimed at the particular cause.  In some cases, however, outpatient surgery can be improve long-standing nasal blockage and significantly improve your quality of life!