KNOWING NOSES: Beyond the deviated septum as the cause of nasal obstruction

As a combination facial plastic surgeon and otolaryngologist (Ear, Nose, and Throat) doctor who specializes in treating the various aesthetic and functional problems with the nose, I see many patients who suffer from breathing problems. “My nose is blocked,” is a common complaint. This is often proceeded by, “I have a deviated septum.” As true as this diagnosis may be, many are unaware of the other aspects of nasal breathing which may also aggravate their nasal blockage. In fact, if these other aspects are not adequately diagnosed, then nasal breathing problems will persist despite having the septum corrected.

The nose is a three-dimensional structure, thus a three-dimensional approach is required to determine the cause(s) of the obstruction. It has become clear in my work on nasal breathing that the septum is only ONE of THREE areas that contribute to nasal blockage. Imagine, if you will, your nose to be like a tent, where the septum makes up the center pole of the tent and the sidewalls of the nose make up the sides of the tent. If either the walls of the tent collapse or if the pole is not in the center, then the space available on either side becomes narrowed. In the same manner, if the sidewall of the nose is weak and collapses when we breathe then the nasal passage on that side will become narrowed making breathing more difficult. The solution is not to simply widen the nose (and definitely not to narrow it further, as many not cautious surgeons will do when performing their typical rhinoplasty), but instead to support the sidewall of the nose to prevent it from collapsing when we breathe.

To take the tent example one step further, imagine if in the middle of the tent there was a large, rolled-up sleeping bag. We have structures inside our noses called turbinates- these are like the sleeping bags. They mainly serve the purpose of warming and humidifying the air we breathe before it reaches our lungs. If these turbinates become too large, however, they too can block our breathing, and may need to be reduced in size. Oftentimes, I see patients who may have had a previous turbinate reduction or septoplasty or both and still present with nasal blockage. In these patients, I tend to find that weakness in the sidewall of the nose is causing some narrowing or that specific, critical areas of the septum remain deviated. Proper treatment first requires proper diagnosis as not every cause of nasal breathing problems is due to a deviated septum.

Dr. Anthony Bared is a board certified otolaryngologist, fellowship trained in facial plastic surgery. He is in private practice, together with Dr. Jeffrey Epstein, with offices in South Miami and Aventura, and a consultation office in Tampa. He devotes his practice to the management of all problems with the nose- breathing, aesthetics, and reparative procedures.

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