I have trouble breathing through my nose but my doctor says it looks normal and I don't need a rhinoplasty. What should I do? Could my doctor be wrong?
Trouble Breathing Through my Nose - Do or Don't Need Rhinoplasty?
Doctor Answers 19
See a nose specialist if you have rhinoplasty breathing problems
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.
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Reasons for poor nasal breathing
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.
Rhinoplasty isn't always the answer to nasal obstruction
Nasal obstruction is a complicated issue that is all too often ignored or attributed to “allergies,” “sinuses,” or to a “deviated septum.” Here at Profiles we often have patients who present to us who have been previously evaluated by other physicians who were unable to determine the cause of nasal obstruction.
We always begin by explaining that it is important to understand that nasal obstruction is a subjective sensation and that it occasionally does not correlate with anatomic problems. In other words, some people can have a slightly deviated septum and complain profusely of their difficulty breathing, while other people are completely obstructed on one side of the nose without ever even realizing they have a problem. So if you have trouble breathing through your nose, it is important to let us do a thorough evaluation. It is true that oftentimes nasal obstruction is due to:
- A Deviated Septum- where the midline cartilage and/or bone that separates the two sides of your nose is crooked
- Nasal Allergies- whether seasonal or year-round.
- “Sinus Problems”- This diagnosis is unfortunately all too commonly applied to patients without proper evaluation.
There are other very important causes of nasal obstruction that are often overlooked on examination. These include:
- Nasal valve obstruction, which refers to excessive narrowing of the nasal valve area, the narrowest part of your nose internally.
This can happen during normal breathing, during sleep, or only during deep breathing, such as while exercising. An experienced rhinoplasty surgeon will be able to identify this cause during a thorough examination.
The good news is that these and many other causes of poor breathing are treatable. Nasal obstruction is a complex problem and there are numerous possible explanations with even more possible solutions. We recognize how nagging this problem can be and we understand how complex the solution is.
The important thing for you is to find the doctor who will take the time to find out what your source of obstruction is and more importantly knows how to correct this problem. For further info we recommend you go to our Modern Rhinoplasty online book and read further on Functional Rhinoplasty.
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Do I need a rhinoplasty for breathing issues?
Trouble Breathing Throgh My Nose
Ok so here's what you need to know. First of all there are many causes of difficulty breathing and not all of them can be corrected with surgery. For example if you have a allergy component it will NEVER get better with surgery and needs medication. The things that get better with surgery and WILL help with breathing are: Correction of a deviated septum and Reduction of the inferior turbinates. Now be careful because if you have a cosmetic rhinoplasty sometimes peoples breathing gets WORSE.
Hope that helps
Breathing problems are due to many problems
Your breathing problems may be due to may sources. Some include:
-Small nasal passage due to internal valve stenosis
I would consult with a nasal specialist to see what your problem is caused by.
Rhinoplasty vs Septoplasty
Rhinoplasty implies aesthetic and cosmetic changes to the nose. You may need internal and functional surgery, such as septoplasty (straightening of deviated septum), turbinate reduction, and/or nasal valve correction. First and foremost, please see an ENT specialist to determine the functional issues.
Trouble Breathing Through Nose
Nasal obstruction may be misdiagnosed. Therefore, it would be best to consult with 3 -4 board certified plastic surgeons to understand your options.
Trouble breathing through nose, Rhinoplasty or not?
I have performed Rhinoplasty for over 20 years and this is a perfect example of a time that a patient needs in person consultations. Breathing issues best addressed with a Septoplasty and Rhinoplasty would be deviated septal cartilage and or bone or enlarged turbinates. Nasal examination would determine whether, or not, these were present.
There are a lot of reasons why we have difficulty breathing. Generally speaking we can think of difficulty with breathing as either a medical or surgical problem. It behooves you to get examined by a physician trained in allergy, or general medicine to evaluate your problem initially. If it appears that yours is a problem of physical obstruction or distortion of your airway, they can direct you to a physician who can resolve your problem by a through examination, diagnosis and usually a surgical intervention to relieve your problem.
Board Certified Plastic Surgeons are trained to do nose surgery (rhinoplasty), you should consult with your doctor to find a surgeon who might be a good choice for you.
I hope this information has been useful to you.
Jon I Sattler, MD, Board Certified Plastic Surgeon, Glendora, California
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.