What are common causes of nasal obstruction?
Common causes of nasal obstruction include a deviated nasal septum, nasal turbinate enlargement and nasal polyps (benign growths).
Deviated nasal septum:
The midline of the nose consists of a cartilage and bony nasal septum that separates the two sides of the nasal cavity. A deviation or bend in this structure can be present at birth or can occur following a nasal fracture. The obstruction caused by such a deviation can be corrected by surgically straightening the septum, called a septoplasty. A septoplasty is a commonly performed outpatient surgery done through incisions within the nasal cavity, removing the obstructing portion of bone and cartilage.
Nasal turbinate enlargement:
The nasal turbinates are three bony and soft-tissue structures lining the sides of the nasal cavity. As part of the normal nasal cycle, the turbinates alternately swell and enlarge. In some persons, the turbinates can be excessively large, resulting in significant nasal obstruction. Allergy treatment, typically with nasal steroid sprays, may help to decrease this swelling. When allergy management does sufficiently relieve nasal obstruction, the inferior turbinates can be surgically reduced. In many cases this can be done as an office procedure.
Nasal polyps are a type of inflammatory tissue that can grow in the nasal cavity and sinuses. They occur more frequently in persons with allergies and/or asthma. Nasal obstruction is the most common symptom. The sinus drainage tracts may also be blocked, resulting in chronic sinus disease. Nasal polyps are controlled with steroid sprays as well as removal by endoscopic surgery. Persons whose polyps arise from asthma may have serious allergic reactions to aspirin.
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What causes sinusitis and how is it treated?
Infection of the sinus cavities often occurs due to inflammation and obstruction of the sinus drainage pathways. Typical symptoms of a sinus infection include facial pain and pressure, nasal obstruction, yellow or green nasal drainage, fatigue and fever. Treatment of a sinus infection may include nasal decongestants and antibiotics. People with chronic sinus drainage may benefit from endoscopic sinus surgery.
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At what point would my child benefit from a tonsillectomy and adenoidectomy?
Surgical removal of the tonsils and adenoids in children is performed for two primary reasons: recurrent tonsil/adenoid infections and snoring with associated sleep apnea.
As a general guideline, a tonsillectomy is recommended in patients with seven or more tonsil infections in one year, five infections a year for two years, or three infections for three or more years.
Enlargement of tonsil and adenoid tissue in children can obstruct airways during sleep. Children with sleep apnea typically are mouth breathers who snore loudly and can be heard to stop breathing or make gasping noises during sleep. Sleep apnea results in fragmented sleep that can lead to daytime fatigue or hyperactivity, failure to thrive, difficulties in concentrating, and occasional problems with bedwetting.
Tonsils and adenoids are removed through the mouth with no external scars. In most children, this is outpatient surgery.
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What causes my hoarseness?
Hoarseness, due to irritation of the larynx, is commonly caused by upper respiratory infections, reflux of stomach acid and/or postnasal drip.
Upper respiratory infections:
People frequently develop a persistent cough following a common cold. A cycle may develop in which episodic coughing results in throat irritation, which causes more coughing and more irritation. The larynx then becomes even more susceptible to other irritants such as acid reflux and posterior drainage from the nose. It is important to break the coughing cycle by maintaining adequate hydration, taking throat lozenges, and avoiding throat clearing.
Gastrointestinal Reflux Disease (GERD):
Acid from the stomach can reflux up through the esophagus to the larynx. The resulting acid exposure can cause a multitude of symptoms, including hoarseness, throat discomfort, swallowing problems and a feeling of a foreign body caught in the throat. Acid reflux may occur at night, so that sleeping patients do not notice symptoms of heartburn. Treatment of GERD includes antacids, elevating the head of the bed, changing the diet, and avoiding caffeine and alcohol.
Mucous drainage from the nose can cause throat irritation and hoarseness. Nasal steroid sprays and non-sedating antihistamines may help reduce the amount of drainage.
Less common causes of hoarseness and voice change include decreased thyroid function, vocal cord paralysis, vocal cord nodules or polyps, and tumors of the larynx. Hoarseness lasting more than four-six weeks should be evaluated by a physician. Otolaryngologists can visualize the both mirrors and flexible fiber optic telescopes.
What can be done about my snoring?
Snoring is a common problem that may occur alone or in combination with obstructive sleep apnea.
Snoring typically is caused by vibration of tissues within the oral pharynx (the uvula and palate). Nasal obstruction can be another cause. In mild snoring, these measures may help: losing weight, sleeping on your side rather than your back, avoiding sedatives and alcohol. Surgery can reduce the size of the soft tissue of uvula and palate, and also relieve nasal obstruction. The PAMF Department of Otolaryngology uses a carbon dioxide laser to remove excess uvular and palatal soft tissue, an office procedure using local anesthesia. Office turbinate surgery may also help snoring by improving nasal breathing.
Obstructive Sleep Apnea:
Obstructive apnea is a cessation of breathing that last ten seconds or more. Repeated episodes can significantly disrupt sleep. Manifestations of sleep apnea include snoring, restless sleep, and daytime fatigue. Many advances have been made in treatment of sleep apnea.