Trouble Breathing Through my Nose - Do or Don't Need Rhinoplasty?

Question

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?

C. Spencer Cochran, MD · Answer

There are many reasons that patients experience symptoms of nasal obstruction.  These can include structural abnormalities such as a deviated septum, narrowing of the mid-vault, and nostril collapse. Functional causes of nasal obstruction include swelling of the nasal passages secondary to nasal allergies (hay fever), enlarged turbinates, sinusitis, nasal polyps, and tumors.
Rhinoplasty can improve breathign problems that arise from structural problems and can even - in some cases - lessen the effects of the functional issues. However, rhinoplasty alone will not "cure" the functional problems.
Seek one or more second opinions -- preferably from an ENT doctor who specializes in nasal disorders -- to make sure your diagnosis is correct. After the correct diagnosis is confirmed (or made) then choose a rhinoplasty surgeon who you feel comfortable with and understands your goals and desires.

Matthew Richardson, MD · Answer

There are many different reasons why a patient may have trouble breathing through the nose. Most commonly, a septal deviation and/or enlarged turbinates are the problem. There are also things such as nasal valve collapse, chronic sinusitis, enlarged adenoids, dry mucosa, etc that could cause nasal obstruction and are often less obvious.
A detailed history and exam would be needed to determine the etiology and proper treatment. A nasal expert like a facial plastic surgeon or ENT surgeon would probably be the best place to start.
All the best,

Christopher Cote, MD · Answer

In general, rhinoplasty is surgery done to re-shape the external nose.  There are other procedures done to improve the internal breathing passages. These include septoplasty and turbinoplasty.  So it can depend on your exam just what needs to be done. For example, a twisted nose may need correction so that you can breathe better.  Your question may more be about the terminology and understanding what treatment is needed to improve your nasal passages.  An otolaryngologist (ENT) should be able to perform a complete exam as assess the causes of your breathing.

Rady Rahban, MD, FACS · Answer

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

	Dr Rahban

Babak Azizzadeh, MD, FACS · Answer

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.

Etai Funk, MD · Answer

Difficulty breathing through your nose can be due to numerous causes. You may have a deviated septum, valve issues, or turbinate hypertrophy. If you are seeking correction of any external disproportion to your nose, you should seek a surgeon that can treat both the nasal airway and appearance of the nose. Good luck.

John M. Hilinski, MD · Answer

Nasal obstruction, or difficulty breathing through the nose, can be a complicated issue in many patients.

There is a significant percentage of patients who have trouble breathing through the nose related to a deviated septum and/or turbinate enlargement. This is something that can be quickly diagnosed in the office setting by a trained plastic surgeon who is experienced in nose surgery. Fortunately, repair of a deviated septum and turbinate enlargement is a relatively straight-forward procedure. In a vast majority of septoplasty and turbinate reduction cases, there is no change to the appearance of the nose.

There are, however, some cases of nasal obstruction that do require rhinoplasty techniques to provide improvement in nasal function. This does not mean that the goal of the surgery is cosmetic enhancement of the nose. The goal of the surgery is to repair the anatomic problem causing the obstruction, which is why some people refer to this as a 'functional rhinoplasty' procedure. Where the confusion might lie is that some patients will see a passive improvement in the shape of their nose as a result of a functional rhinoplasty.

A good example of this is placement of spreader grafts. These are grafts that are usually placed to help open what is called the internal nasal valve. This corresponds to the middle portion of the nasal bridge (also called the middle vault). Some people have a congenitally depressed or pinched middle vault that contributes to a breathing problem. This also creates the appearance of abnormal shadows in the middle of the nose that is cosmetically undesirable. The spreader graft is placed to stent open the middle portion of the nose with the hope of improving the patient's breathing. The beneficial side effect of this is a smoother looking bridge. This is just one example of how 'rhinoplasty' technique can be used to help with functional problems of the nose while also improving the cosmetic appearance.

You would be best off seeing a plastic surgeon who also has training and experience specifically in problems with the nose.

Behrooz Torkian, MD · Answer

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

Michael A. Persky, MD · Answer

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.

Richard W. Westreich, MD · Answer

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.