Do you have nasal blockage and have to mouth breathe at times or know someone who does?

We know that finding information about nasal obstruction can be difficult to find and we would like to help.

This nasal obstruction blog post was written by an ear, nose and throat surgeon who has performed thousands of flexible fiber optic evaluations of the upper airway which includes evaluation of the nose and nasal cavity structures.

As part of the background for this blog post, we searched the internet for frequently asked questions and answered them.

The goal of the blog post is to educate you on nasal obstruction, why it occurs, what can block the nasal airway and can also lead to nasal congestion.

Additionally, the goal is to provide information about what the relationship is between nasal congestion with snoring and obstructive sleep apnea.

This blog post provides illustrations that help to explain the different areas of the nose that can cause nasal obstruction, which can lead to mouth breathing in some cases.

Deviated nose in a woman. Note that the nasal bones (top part of the nose) and the cartilage (lower half of the nose) are deviated. The shape is like a reverse-c shape. SkullMD.com
Deviated nose in a woman. Note that the nasal bones (top part of the nose) and the cartilage (lower half of the nose) are deviated. The shape is like a reverse-c shape.

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Summary information about nasal obstruction:

Nasal obstruction is common in adults and occurs when the nose is physically blocked or obstructed.

Common sites of nasal obstruction in adults include the external nose, dynamic collapse of the nostrils, a deviated nasal septum, inferior turbinate hypertrophy, nasal polyps, and growths in the nose (intranasal or nasopharyngeal masses)).

In adults, a deviated nasal septum and large inferior turbinates are common causes for nasal obstruction.

Medications are usually tried first and if there is not enough improvement, then the surgeon may recommend surgery.

Common surgeries in adults include rhinoplasty, septoplasty, turbinoplasty, nasal polypectomy, and adenoidectomy.

Causes of nasal obstruction:

There are many causes of chronic nasal obstruction, they include:

  • trauma to the external nose;
  • weak nostrils that allow for dynamic collapse;
  • deviated nasal septum;
  • inferior turbinate hypertrophy;
  • nasal polyps; and
  • growths in the nose (intranasal or nasopharyngeal masses).
Deviated nasal septum in a woman. SkullMD.com
Deviated nasal septum in a woman.

How common is nasal obstruction?

Nasal obstruction has been reported to affect up to 40% of the population.1

Diagnosis, Symptoms

Nasal obstruction can be one side or both sides of the nose.

Obstruction on both sides is more common when the cause affects both sides such as allergic rhinitis, large inferior turbinates, nasal polyps, and enlarged adenoids.

In patients with significant nasal obstruction, mouth breathing may present.

Anatomy/Physiology

Adults tend to have acquired nasal obstruction.

Trauma can cause a deviated external nose and a deviated nasal septum.

Environmental allergies and associated allergic rhinitis can trigger nasal obstruction.

Common sites for nasal obstruction in adults include:

  • external nasal deformity (that causes internal narrowing of the nose);
  • deviated nasal septum;
  • inferior turbinate hypertrophy;
  • nasal polyps (i.e. chronic sinusitis); and
  • adenoid hypertrophy.
Nasal obstruction in an adult man. He has a deviated septum with a crooked nose. The nose is causing so much obstruction that he needs to mouth breathe. BladeMD.com
Nasal obstruction in an adult man. He has a deviated septum with a crooked nose. The nose is causing so much obstruction that he needs to mouth breathe.

Testing for nasal obstruction

Nasal endoscopy and imaging studies can be used to evaluate the obstruction.

Imaging studies include:

  • CT (computed tomography) scans;
  • MRI (magnetic resonance imaging) scans; and
  • acoustic rhinometry has also been used to evaluate the nasal resistance in the upper airway.2

What is the natural history of nasal obstruction?

As an adult, observation might not improve the symptoms if they have been present for some time.

Medical Management

Medications that treat nasal and environmental allergies include:

  • nasal steroids such as fluticasone;
  • antihistamines such as cetirizine;
  • sinus rinses;
  • oral steroids; such as prednisone; and
  • anti-leukotrienes such as montelukast.

A systematic review by Sun and colleagues found the Chinese herbal medicine has shown a good safety profile and had good clinical efficacy in reducing snoring, mouth breathing and nasal obstruction.3

However, the authors also stated that this needed to be confirmed by higher quality, randomized controlled trials.3

What are the surgical options for nasal obstruction?

Medical management can fail, and for those who fail, there is an option to see an ear, nose and throat surgeon.

There are several surgeries to treat nasal obstruction depending on the cause, common surgeries include:

  • rhinoplasty;
  • septoplasty;
  • bilateral inferior turbinoplasty;
  • nasal polypectomy; and
  • adenoidectomy.
Illustration of the nose of a woman viewed from the side. Cartilage and bone can be seen. SkullMD.com
Illustration of the nose of a woman viewed from the side. Cartilage and bone can be seen.
Man after nasal surgery for a crooked nose. He is breathing much better and externally, his nose is much straighter. BladeMD.com
Man after nasal surgery for a crooked nose. He is breathing much better and externally, his nose is much straighter.

Does surgery to treat nasal obstruction result in an improvement in the long face and make it more normal in length?

The study found that there was a decrease in the facial length, but not always significantly; the average was about -0.76 mm.4

Government Disclaimer: The views expressed in this website are those of the author(s) and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

References:

1.            Osborn JL, Sacks R. Chapter 2: Nasal obstruction. Am J Rhinol Allergy. 2013;27 Suppl 1:S7-8.

2.            Melo AC, Gomes Ade O, Cavalcanti AS, Silva HJ. Acoustic rhinometry in mouth breathing patients: a systematic review. Braz J Otorhinolaryngol. 2015;81(2):212-218.

3.            Sun YL, Zheng HT, Tao JL, et al. Effectiveness and safety of Chinese herbal medicine for pediatric adenoid hypertrophy: A meta-analysis. Int J Pediatr Otorhinolaryngol. 2019;119:79-85.

4.            do Nascimento RR, Masterson D, Trindade Mattos C, de Vasconcellos Vilella O. Facial growth direction after surgical intervention to relieve mouth breathing: a systematic review and meta-analysis. J Orofac Orthop. 2018;79(6):412-426.