Nasal Congestion

What is nasal congestion?

Nasal congestion is a symptom which can mean different things to different people.  For some people, this means sinus pressure; for others, this means poor nasal airflow.  Most ENT doctors refer to the problem of nasal stuffiness or restricted airflow of the nose as nasal obstruction.

What causes nasal obstruction?

Many things.  To understand the cause of nasal obstruction, we must first look at the structure of the nose.  In the middle of the inside of the nose is a flat sheet of cartilage and bone called the septum.  On the sidewall of the inside of the nose is a strip of tissue called a turbinate.   Everyone’s septum and turbinates are unique in size and shape – like a fingerprint.  Most cases of nasal obstruction are caused by one of three situations:

  1. Enlarged turbinates
  2. Crooked septum
  3. Both enlarged turbinates and crooked septum

What is a turbinate?

A turbinate is a strip of tissue along the lining of the nose.  It can swell or shrink based on many factors.  When swollen, it blocks airflow; when decongested, it permits airflow.  The turbinate is responsible for the back-and-forth nasal blockage people experience.  For instance, when one rolls over in bed and one side of the nose opens and the other closes off, it is the turbinate swelling on one side and shrinking on the other that is responsible for this change.

What causes enlarged turbinates?

Turbinates vary in shape and size just like other parts of the body.  In some cases, they are simply too big for the nose.  In other cases, they are enlarged because of allergies or infection.  Regardless of the cause, the oversized turbinate problem can be fixed through very simple office-based interventions.

What causes a crooked (deviated) septum?

Many things.  First, contrary to what some people may say, you DO NOT have to have had a broken nose in order to have a deviated septum.  The septum can warp or shift over time without ever having been injured.  Of course, an injury to the nose – however slight – will predispose a patient to develop a crooked septum, even if there is no change to the shape of the nose.

How do I know what causes my nasal obstruction problem?

The best way to find out what is causing a problem with nasal obstruction is to be seen by one of our ENT specialists.  They will carefully interview you and review your history.  They will try to understand your individual problem and your concerns; they will also perform a comprehensive examination.  This will result in a clear understanding of your nasal obstruction problem and lead to a series of treatment options.

How is situation 1 – “enlarged turbinates” – treated?

Enlarged turbinates can be treated through a simple office procedure called “turbinoplasty.”  This 15-minute procedure permanently reduces in turbinate size and improves airflow. It causes almost no discomfort during the procedure; there is no post-treatment limitation in activity and no post-treatment pain.  It is very effective.  See the link for “Endoscopic Turbinoplasty.”

How is situation 2 – “crooked (deviated) septum” – treated?

When the septum is severely deviated, the only option is a minor nasal surgery.  This procedure is done under anesthesia, and patients go home the same day.  No packing is used, though a thin soft silicone sheet keeps the repaired septum stable.  This is removed in the office a few days after surgery and is painless.  See the link to “Septoplasty.”

How is situation 3 – “crooked (deviated) septum and enlarged turbinates” – treated?

As in situation 2, the septum is repaired.  The turbinates are also treated at the same time.

I know someone who had nasal surgery, and it didn’t help.  Why?

There are a number of reasons for this, and our physicians occasionally hear this from new patients.  In most cases, this results from the previous surgeon fixing the septum but ignoring the turbinate.  Only through a comprehensive exam can the exact cause be determined.