I have trouble breathing through my nose. My doctor says it looks OK and I don't need a rhinoplasty. What should I do?

Difficulty breathing through your nose can be alleviated through other procedures that do not alter the shape of your nose.  Procedures such as Septoplasty, Turbinate reduction or spreader grafts , are performed to improve a person’s functional breathing from within the nose which allows better airflow dynamic, and sense of smell.  A rhinoplasty is performed for purely cosmetic reasons and can be done in conjunction with Septoplasty and Turbinectomy.  It can also improve facial headaches and allow the sinuses to drain better.

Nasal obstruction is rarely able to be diagnosed from an external examination.  Even an internal examination may not provide adequate assessment of nasal airflow in a few cases.

Your best bet is to have a specialist evaluate your nose.  Most Facial Plastic Surgeons are trained primarily in Otolaryngology - Head and Neck Surgery, and are an excellent starting point for a complete nasal evaluation. 

Your specialist of choice can help you understand what factors are involved in the trouble you experience breathing through your nose.  In some cases surgery is not necessary, and medical treatments, or office procedures may improve your breathing. 

Although surgery may be necessary in some cases, the term "rhinoplasty" generally refers to a surgery that alters both the appearance and the function of the nose, whereas internal procedures that do not affect the appearance such as septoplasty, and inferior turbinate reduction, may be more appropriate procedures for you.

Dr. T

You should make an appointment with a board certified Otolaryngologist (ENT). Tell them your history, have them examine your nose, and give you a diagnosis of why you are having breathing problems. You may have allergies, enlarged inferior turbinates, nasal septal deviation, collapse of your nasal valves, polyps, or some other obstruction that is causing your difficulty with breathing.

If you do need surgery to correct your breathing, internal surgery should correct your obstruction without changing the cosmetic or outward appearance of your nose. At the end of the day, you should be able to breathe.

I am not sure who examined your nose and gave you that advice, but I would imagine that something is being missed if you have subjective symptoms of nasal obstruction.

I am not sure that a Rhinoplasty is what you need for functional improvement. It is more likely that septal surgery or turbinate surgery would address your breathing concerns.

Nasal performance is a complicated interplay of tissues within and outside the nose. In some patients, a very small problem can lead to significant symptoms. Patients of different ethnic backgrounds and nasal architecture will breathe through different areas or levels within the nose itself. A small bony floor deflection may be a problem for one patient but irrelevant for another. Dynamic nostril or nasal sidwall collapse, due to weak nasal cartilages, can also produce poor nasal breathing. This will only be seen if the physician examines the outside of your nose while breathing.

If your obstruction alternates sides, then turbinate issues are likely contributing. If your breathing problems are mostly at night, then it is again likely a turbinate problem (a phenomenon called rhinitis of recombancy).

External nasal deviation usually results in internal deviations of functional significance. Prostate, blood pressure, contraceptive, and thyroid medications can cause nasal obstruction as well as oral contraceptives and hormone replacement therapy. Low thyroid levels can also be a contributing factor.

Without seeing your nose, it is impossible for me to know exactly what your problem is. However, here are some anatomical reasons (in likely order) for nasal obstruction that may be missed by a doctor that does not specialize in treating these problems:

• Slight septal deviation or dislocation in an eloquent area of the nose, such as the nasal valve

• Bony septal deviation that may only be seen with nasal endoscopic examination (using a small camera)

• Inferior turbinate hypertrophy

• Nasal sidewall collapse

• Adenoid hypertrophy

• A growth in the nose, such as a polyp

• Choanal atresia (where the opening in the back of the nose never formed)

• And many more causes

I would recommend examination and consultation with a nasal specialist, such as an ENT or Facial Plastic Surgeon specializing in functional rhinoplasty and septoplasty corrections.