Breathing Problems

The purpose of the nose is to warm, humidify, and filter the air as it comes into the body. When someone has a breathing problem, the nose is not able to serve its purpose. Breathing problems occur in varying severities and durations. A physical examination and other diagnostic tests are used to assess breathing problems. Some common breathing problems related to nasal function are discussed below:

Deviated Septum - The nasal septum is the divider in the middle of your nose. It is mostly made up of cartilage covered by mucous membrane forming a firm but pliable structure. Ideally, the septum is in the midline, separating the nose into equal parts and allowing air to flow equally in and out of each nostril. A deviated septum is when the septum is shifted away from the center. This obstructs airflow, making it difficult to breathe through the nose. In some cases, a deviated septum can block drainage from the sinuses which can lead to sinus infections.

Some of the symptoms of a deviated septum include:

• Nasal congestion
• Blockage of one or both nostrils
• Mouth breathing
• Recurrent sinus infections
• Recurrent nosebleeds
• Facial pain/headaches
• Post nasal drainage

Septoplasty is the preferred treatment for a severely deviated septum. This is an outpatient procedure involves straightening of the septum which opens airflow through the nostrils. It is performed through the nostrils, therefore there are no outward signs of the surgery such as bruising or changes to the outer appearance of the nose.

Rhinitis - Inflammation of the nasal mucous membrane is called rhinitis. The symptoms of rhinitis include:

• Nasal Congestion
• Nasal drainage
• Sneezing
• Itchy nose

Rhinitis can either be allergic type or non-allergic type.

Allergic Rhinitis - This happens when the body’s immune system over responds to specific allergens, such as pollens, molds, dust mites, animal hair, chemicals, foods, medicines, and insect venom. When the body over reacts to an allergen, antibodies (IgE) attach to mast cells in the lungs, skin, and mucous membranes causing the release of histamine. When histamine is released, the blood vessels dilate causing skin redness and swollen mucous membranes resulting in symptoms such as sneezing, congestion, itching, headaches, and itchy, watery eyes.

Allergic rhinitis can be seasonal or perennial. Ragweed allergies occur in late summer or spring. Sensitivity to tree pollen occurs in late March or early April. Mold allergies occur in October or November when the leaves fall from the trees. Sensitivity to substances such as pet hair, household mold, and dust mites occur year-round. This is termed perennial allergic rhinitis.

Non-allergic Rhinitis - This type of rhinitis does not involve a hypersensitivity to specific allergens. It can be triggered by different environmental factors such as cigarette smoke, pollutants, strong odors, and cold air. It can also be due to nasal obstruction, a deviated septum, infections, and misuse of sinus medications such as decongestants.

Sinusitis - The sinuses are hollow spaces in the bones around the nose that drain to the nose through small channels. When the channels are open, air from the nose can flow into the sinuses and the mucus made in the sinuses can drain into the nose. Sinusitis occurs when viruses or bacteria infect the sinuses, causing swelling of the sinus lining, blockage of the drainage channels, and a buildup of mucus and pus. Sinusitis is characterized by cloudy or colored drainage from the nose, nasal blockage, congestion, reduced smell sense, bad breath, watery eyes, and facial pressure. Acute viral sinusitis is likely if you have been sick less than ten days and you are not getting worse. Acute bacterial sinusitis is likely if you do not improve at all within ten days or when you get worse within ten days after beginning to improve. Viral sinusitis does not benefit from antibiotics. Some patients with bacterial sinusitis may improve faster with an antibiotic. If you have returning symptoms of sinusitis, you may have chronic sinusitis. It’s important to have an evaluation if you have recurring sinus problems so a specialized treatment plan can be developed for you.

If you are experiencing breathing problems, contact our office to schedule an appointment with one of our otolaryngologists.

Nasal Fracture

Falls, contact sports, recreation activities, and accidents are all causes of nose injuries. Most nose injuries include pain, swelling, and bruising. A nasal fracture occurs when there is a break or crack in the nasal bones. Symptoms of a nasal fracture include:

• Pain when touched
• Swelling
• Bleeding from the nose
• Bruising
• Nasal obstruction
• Change in the appearance of the nose

If you have unstoppable bleeding, difficulty breathing, a change in the shape of the nose, a puncture of the skin over the nose, or a collapse of the bridge of the nose, you should seek medical attention. A nasal fracture is confirmed with a physical examination. Sometimes an imaging study is necessary, but most times it is unnecessary. The treatment for a nasal fracture is based on the severity of the fracture. A minor fracture may not require medical attention at all where as a severe fracture could require surgery.

If you have injured your nose, please contact our office and schedule an appointment with one of our otolaryngologists.

Snoring/Sleep Apnea

Snoring occurs when there is an obstruction to the air flow through the back of the mouth and nose which causes the tissue in the back of the throat to vibrate creating a snoring sound. Some causes of snoring include:

• Enlarged or infected tonsils or adenoids
• Nasal obstruction due to a deviated septum
• Obesity
• Alcohol and drug use
• Some medications
• Allergies
• Soft tissue abnormalities

If your snoring is interfering with your restful sleep or your partners sleep, it’s important to find a solution.

Sleep Apnea happens when the relaxed muscles in the back of the throat cause the throat to close off, obstructing air flow. This usually occurs anywhere from 20 seconds to up to three minutes, lowering the amount of oxygen in the blood and causing the heart to work harder. The cycle of snoring, periods of apnea, and awakening disrupt the normal sleep pattern, resulting in fatigue, slowed reaction time, memory loss, and confused thinking. High blood pressure, heart attack, stroke, anxiety, accidents, and depression are some other potential complications of sleep apnea. The symptoms of obstructive sleep apnea (OSA) include:

• Loud snoring
• Breaks in breath during sleep
• Waking up gasping or choking
• Daytime sleepiness
• Headaches in the mornings
• Frequent urination at night time
• Irritability, mood changes, depression, trouble concentrating

In order to diagnose sleep apnea, a physical examination is performed and in most cases a sleep test is recommended. The sleep test will determine the exact cause and the severity of the sleep apnea. In children, snoring and sleep apnea may be a sign of problems with the tonsils and adenoids. In adults, there are often several contributors to the problem. Some of the factors that contribute to snoring and sleep apnea include:

• Poor muscle tone of the tongue and throat- over relaxation of the tongue and throat muscles can result in airway obstruction.
• Bulky throat tissue- Airway narrowing can be caused by enlarged tonsils and adenoids, large tongues, or extra neck tissue due to obesity.
• Elongated soft palate/uvula- The opening from the nose to the throat is narrowed with a long soft palate and can result in noisy breathing, snoring, and OSA.
• Blocked nasal passageways- nasal congestion due to allergies or sinusitis as well as nasal obstruction due to a deviated septum can contribute to snoring and OSA.

Treatment for snoring and sleep apnea depend on the severity and the contributing factors.

If you are a heavy snorer and it negatively affects the quality of your sleep or your partner’s sleep, have a medical examination to ensure that you do not have sleep apnea. An evaluation by an ENT specialist can determine the reason for your snoring, which may be allergies, infection, nasal obstruction, or enlarged tonsils and adenoids. A sleep study may be required to determine if OSA is a problem.

Obstructive sleep apnea is often treated with a CPAP (continuous positive airway pressure) device. It is worn during sleep and helps to open the airway using positive pressure through the nose and/or mouth. In mild cases of OSA, treatment may consist of nasal decongestants, inhaled nasal steroids, or oral appliances. When obesity is a factor, significant weight loss can improve snoring and sleep apnea. In severe cases, surgical intervention addressing the soft palate and uvula, tonsils and adenoids, or deviated septum may be indicated.

If you suffer from disruptive snoring or if you think you might have sleep apnea, please contact our office and schedule an appointment with one of our otolaryngologists.