Ask the Doctors

By Dr. Andrew Ordon

Can nasal surgery help solve breathing problems?

To understand how undergoing surgery of the nose can help with better breathing, it helps to know a little bit about the physiology of the nose and how air moves through it. Our nasal cavity has a wall or partition in the middle that divides it into two equal air passages, which helps air flow better and also serves to filter and warm the air as it goes in and out. You want that partition, called the septum, to be as straight as possible because that makes breathing more efficient.

The septum is made up of both bone and cartilage, and either one or both of those components can be crooked, making it difficult to breathe through the nose. When we do septal surgery, typically we’re manipulating and straightening the cartilage, the bone or both. There are two other parts of the nose we also address in surgery: the turbinates, which are like little shelves on the outer wall of the nasal cavity, and the nasal valve.

If the turbinates are too large as a result of allergies or inflammation, we manipulate the lowest, largest one, the inferior turbinate, by physically pushing it over and also using coblation (a procedure involving radiofrequency energy pulses) that helps shrink it.

Next, we can put little pieces of cartilage, called spreader grafts, in the nasal valve area to dramatically improve airflow. It’s like having a permanent breathing strip opening up your nasal airway.

Underlying allergies that make the nose overreact and become inflamed, known as vasomotor rhinitis, can really cause problems if there’s also a deviated septum. The person may feel an obstruction, or it can manifest as snoring and/or sleep apnea. Fixing the septum doesn’t cure the allergies, but making sure the nasal airway is as straight as possible can make them much more tolerable by improving breathing.

When a patient is considering surgery to address breathing problems, first I obtain a medical history and ask about symptoms. Next, I’ll directly observe airflow by covering one nostril at a time with my thumb and assess how air moves through each nasal passage. I also gently pull outward on the patient’s cheeks, opening up the nasal valve — if they can feel a dramatic improvement, that’s a sign they may benefit. Finally, I’ll look inside the nose with a scope and check for a deviated septum, enlarged turbinates and whether the nasal valve area is visibly constricted or tight.

Nasal surgery has become more and more sophisticated, and we can tailor each operation to what the patient needs and wants. We’ve also come a long way when it comes to recovery — specialized instruments, long lasting anesthetic and other measures can reduce bruising and swelling and speed up the healing process considerably. And although the final results can take several months, most people say, “Wow, I am breathing better!” right away.