Why can’t I breathe through my nose?

Nasal obstruction

 is the inability to breathe through the nose

We have all experienced this problem after a cold but imagine living with it! Fortunately there’s a lot that can be done.

Typically we inhale eighteen to twenty thousand litres of air a day. When we do this through our nose the air is warmed and humidified and larger particles are filtered out. This also facilitates our sense of smell. So when  we can’t breathe through our nose we tend to suffer with sore throats, disturbed sleep, lack of taste and smell and we might snore. If we’re unlucky we might get sinusitis as well! Not surprisingly there are many studies which attest to the negative impact on our sense of well being from not being able to breathe through the nose.

Nasal polyps

What are the causes?

There are numerous causes of nasal obstruction and an accurate diagnosis is essential in managing this distressing symptom. Difficulty breathing through the nose is commonly caused by problems with the nasal lining such as allergic rhinitis or polyps but it might be a manifestation of systemic disease (an underactive thyroid for example) or a side effect of medication .

There can also be problems with the bony and cartilaginous skeleton of the nose. An example of this would be deviation of the partition which divides the two nasal cavities, known as the nasal “septum”. This can either develop as we grow  or  be the result of trauma which is common in certain sports eg riding and rugby.  Review by your doctor after significant nasal injury is important  to ensure that there is no collection of blood in the septum which can become infected and give rise to septal perforation and an unattractive change in the nasal profile.

Unfortunately nasal obstruction can also arise from injudicious nose plastic surgery to alter the shape of the nose –  we are all aware of the pinched appearance  of some celebrity noses. One estimate suggests significant airway compromise in up to 10% of cosmetic rhinoplasty cases performed by sinus surgeons worldwide. The common problems are to leave septal deflections uncorrected and to over-resect  the cartilages in the nasal tip so that they lose their structural integrity and collapse on inspiration.  While these problems are obviously best avoided in the first place, they can be corrected.

How can nasal obstruction be treated?

Many mucosal causes of nasal obstruction can be treated medically. For example having diagnosed a patient as suffering from allergic rhinitis we would recommend a strategy which included allergen avoidance, nasal douching and topical nasal steroids to suppress inflammation, and possibly an antihistamine. In the case of house dust mite sensitivity,  allergen avoidance would include buying a new pillow every year, using a house dust mite impermeable mattress cover, washing bed clothes at above 50ᵒ C. The use of a salt water nasal rinse can be helpful in washing inflammatory particles and mucus from the nose thereby potentiating the effect of topical steroids.

The majority of patients with nasal polyps are also successfully managed by their GP. Obviously if there are concerns that the polyps might be sinister (the obstruction is unilateral or there has been bleeding or eye or teeth symptoms) imaging and biopsy will be required although it is usually possible to provide reassurance to the vast majority of patients after they have had an endoscopy in clinic by a sinus specialist. When nasal polyps don’t respond to medical management surgery will be indicated. Once again there have been significant advances in this over the years and in my practice most surgeries are performed endoscopically  on a day case basis without the need for nasal packing.

As already discussed, nose plastic surgery to alter nasal appearance needs to maintain and enhance the nasal airway. As form and function are closely linked the goal should be a natural unoperated appearance.

What can you do for yourself?

Be aware that nasal obstruction can indicate a systemic problem and that a sudden onset of unilateral obstruction with bleeding and possibly eye and teeth symptoms requires urgent investigation.

Avoid using nasal decongestants long-term.  In the short-term (less than five days) they can  be helpful in providing symptomatic relief,  but when used for longer periods actually exacerbate the problem.

You can be reassured that there has been considerable progress and increasing super-specialisation in nasal surgery.  A properly trained sinus surgeon or rhinologist will be able to make sense of your symptoms, arrive at the correct diagnoses (there may be more than one) and institute appropriate management. And if you need surgery, remember  not all nose operations are the same.