Houston ENT and Allergy Blog

Why Can't I Breathe Well Through My Nose? (Nasal Obstruction and Chronic Sinusitis)

By:
PATRICIA A. MAESO, MD
December 13, 2019

troubling breathing through my nose (1)

Sinus and nasal complaints are common reasons for a visit to your primary care doctor, an allergist or an otolaryngologist (ENT). If you're asking yourself, "what are the reasons why I can't breathe through my nose," two common culprits to consider are a nasal obstruction and chronic sinusitis.

 

Differences Between Nasal Obstruction and Chronic Sinusitis

There are some differences between nasal obstruction and chronic sinusitis.

Nasal Obstruction

Nasal obstruction is a blockage of your nasal cavity or nose and can be due to various reasons. In most cases, nasal obstruction is only temporary and is caused by:

  • Allergies

  • A cold

  • Medication

  • A sinus infection

Other nasal obstructions, however, require medical intervention.

According to a study published in the National Institutes of Health, among all surveyed patients, the prevalence was:

  • Septal deviation (76%)

  • Inferior turbinate hypertrophy (72%)

  • Nasal valve collapse (67%)

Patients visiting their primary care doctor or Ear, Nose and Throat (ENT) doctor often do so because of nasal obstruction. It can seriously affect your quality of life by affecting your comfort breathing. It's also a substantial component of obstructive sleep apnea (OSA) and could impact your sleep quality greatly. Athletes with nasal obstruction can experience a negative impact on their ability to perform to their full potential.

 

Causes of Nasal Obstruction

There are several common causes of nasal obstruction:

  1. Deviated nasal septum: Your nasal septum is a wall-like structure dividing your right and left nostrils. When one is crooked, it's called a deviated septum. Many individuals have some degree of septal deviations. Symptoms include a runny nose and a hard time breathing through your nose (particularly one nostril).

  2. Choanal atresia: A congenital defect where you have extra tissue in your nasal airway that is causing a full or partial blockage, making it difficult to breathe.

  3. Inferior turbinate hypertrophy: Your nasal cavity contains turbinates (bony structures) that are vulnerable to irritation from dust and allergies. This leads to swelling and difficulty breathing.

  4. Nasal polyps: These are painless, soft, noncancerous growths on the lining of your sinuses or nasal passages.

  5. Swelling: This involves swelling of your nasal lining because of allergies.

  6. Oversized adenoids: Your adenoids are your glands that sit above the roof of your mouth behind your  nose. When oversized, they can lead to breathing problems and snoring.

  7. Foreign objects in the nose: These can include things like small toys (like marbles), food, beads, paper wads, crayon pieces, erasers, disc magnets, dried beans and button batteries.

Nasal valve stenosis is a more complex cause of nasal obstruction. your nasal valve is the space inside your nose defined to your nose's soft tissue that represents the narrowest part of your nasal passage. Since it's the narrowest part, it often represents the area of nasal obstruction. A variety of reasons can cause your nasal valve to become weak or collapse.

Weakness in the soft tissue and cartilage of your nose is one of the reasons. When the weakness is on the sides of your nose, it can collapse particularly on the inspiration of air that causes nasal obstruction. Your nasal valve can also become narrowed because of normal development, and finally, it can collapse because of prior nasal procedures like rhinoplasty where your cartilage that supports your valve is inadvertently weakened from a prior surgical procedure.

 

Chronic Sinusitis

Sinusitis is inflammation causing sinus:

  • Pressure

  • Pain

  • Swelling

With chronic sinusitis, sinusitis lasts longer than 12 weeks.

However, unlike acute sinusitis, which a sinus infection often causes, chronic sinusitis isn't typically caused by bacteria and doesn't usually get better with your typical treatment like antibiotics. It's often referred to as chronic rhinosinusitis.

According to the Centers for Disease Control and Prevention (CDC), 28.9 million (11.6%) individuals received a sinusitis diagnosis.

 

Causes of Chronic Sinusitis

The most common chronic sinusitis causes are:

  1. A blockage preventing your sinuses from draining: Often this is because of damage to your face or nose, chronic infection, nasal polyps and tumors. Those with a deviated septum have a higher risk of developing chronic sinusitis.

  2. Biofilms: This is a colony of bacteria that makes a thick film similar to teeth plaque. Biofilms are difficult to eliminate, but approaches that cleanse the sinuses like surgery and nasal irrigation could help.

  3. An unusual infection: A lot of sinus infections clear up with standard antibiotics. But, some infections like antibiotic-resistant infections and fungal infections don't go away with standard antibiotic treatment.

  4. Exposure to allergens and irritants: Those with asthma and allergies are more likely of developing chronic sinusitis because these problems can increase irritation and pressure in the sinuses and nasal passages. Individuals with asthma and allergies might react to nasal allergens, secondhand smoke, air pollution, dust particles and other sources of irritation. 

  5. Immune system issues:  Disorders and conditions that weaken your immune system make it harder for your body to fight inflammation and infections. Individuals with cystic fibrosis might be particularly susceptible to chronic sinusitis. Immune system conditions like HIV might also be a culprit.

 

Treatment Options

It's important you have a doctor examine your nasal obstruction or chronic sinusitis so you can receive treatment.

Nasal Obstruction Treatment Options

Ear Nose and Throat (ENT) doctors often treat nasal obstruction with medicines. Many address reversible causes of nasal swelling like underlying allergies. They might prescribe you a nasal steroid spray to reduce inflammation of your turbinates and nose.

Your doctor might suggest you have your adenoids surgically removed if they're causing your nasal obstruction. Most doctors perform adenoidectomies on an outpatient basis.

They might perform surgery to shrink your turbinates if you don't show improvement with medicines. There are a few new surgical approaches that they could use to shrink turbinates, which include a small tissue-shaving device and radiofrequency energy.

Your ENT doctor may recommend balloon sinuplasty to drain the large nasal sinuses, clear blocked sinuses, or reduce inflammation. Balloon sinuplasty is an endoscopic, minimally invasive procedure whereby your doctor inserts a small catheter that has a balloon that can inflate when inside your nasal cavity.  It is typically performed as an in-patient procedure. 

 

Treatment Options for Chronic Sinusitis

Chronic sinusitis isn't typically caused by a bacterial infection. Therefore, antibiotics won't help with this condition. Some ways of treating chronic sinusitis include:

  • Intranasal corticosteroid sprays

  • Avoiding triggers (typically related to environmental factors and allergies)

  • Topical antihistamine pills or sprays

  • Antifungal medicine

  • Surgery (usually for correcting structural problems like a deviated nasal septum)

  • Leukotriene antagonists (pain relievers)

  • Treating an underlying condition ( asthma or allergies)

 

CONTACT HOUSTON ENT & ALLERGY SERVICES IF YOU CAN'T BREATHE WELL THROUGH YOUR NOSE

The next time you wonder to yourself, "why can't I breathe well through my nose," you may want to have your Houston ENT and Allergy Services doctor exam you and see if you're suffering from either a nasal obstruction or chronic sinusitis. In either case, treatment can help to improve your symptoms and restore normal breathing. This will help you not only feel better but could also improve your quality of life.  Request your appointment today. 

 

Learn More About Chronic Sinusitis Here

 

 

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