Question: My allergy medication used to help control my nasal breathing problems, but it no longer helps as much. Why is that?
Answer: There can be several reasons that your allergy medication no longer helps control your breathing problems. One common reason is that your environment might have changed, and therefore you might have been exposed to something that triggers your allergies and increases swelling of the lining of your nose, making it harder to breathe. Another common reason is that as we age, Mother Nature affects our nose just as it does other areas of our body, and things weaken. This weakening, combined with deviations of the septum, essentially reduces the "hallway" of our air passage.
Q: What causes my nose to be blocked?
A: Inflammation and the architecture of the nose are the two factors that influence how well we breathe through our nose. The inflammation and swelling of the internal lining of our nose is usually a result of allergens or local irritants, and therefore, allergies can greatly influence how well we breathe through our nose. Most nasal sprays and allergy medication aim to reduce this swelling.
Secondly, the nose can be divided into three parts, with the structural support of the upper third made up of primarily bone, while the lower two-thirds is supported by cartilage. Interestingly, the lower two-thirds can be considered the "business end" of the nose and has a much greater influence on our nasal breathing. Ironically, if you gently wiggle your nose, you can see that the lower two-thirds is the more flexible end. The bumps and injuries we endure as children learning to walk or teenagers learning to play a sport can slowly weaken the framework.
Q: Are there alternatives to surgery?
A: Yes, there are several alternatives to surgery. First and foremost, work with your physician to ensure you have maximized your medical treatment. This might include allergy sprays, pills, nasal irrigation systems or allergy shots. There is also a growing area of research pointing to the dietary effects on inflammation and therefore nasal obstructive symptoms. So, dietary changes should be considered. Environmental changes should also be considered. Most importantly, focus on reducing allergen exposure in our living environment, which includes changing air filters, allergy-proof pillow and bed covers, humidifiers, etc.
Q: What can be done if those alternatives are ineffective? And, can surgery really eliminate my allergy problems?
A: Surgery cannot directly eliminate allergy problems. However, as you can see, there are two primary reasons why our nose can feel blocked. In the event that treatment of the inflammation has been maximized, surgery to improve the structure of our nose might be of great help. Some surgical options include:
1. Septoplasty, which is straightening of the nasal septum, the "wall" that separates the left and right sides of our nose;
2. Turbinate reduction, which is another procedure that helps to improve our "airway;"
3. Rhinoplasty, which aims to reconstruct the nasal architecture and thereby the support to our nasal air column.
As a facial plastic and reconstructive surgeon, I perform rhinoplasty surgery on patients with previous nasal fractures, patients with difficulty breathing through their noses, for reconstruction after removal of skin cancers, as well as cosmetic reasons. In many cases, the factor causing a bump or abnormality to the external contour of the nose might be the same factor causing breathing difficulties.
To determine whether surgical treatment is an option for you, it is best to schedule a consultation with an otolaryngologist (ear, nose and throat surgeon), facial plastic and reconstructive surgeon, or plastic surgeon.
Dr. Amit Patel is an assistant professor of surgery in the University of Kentucky College of Medicine, a board-certified otolaryngologist-head and neck surgeon and a fellowship-trained facial plastic and reconstructive surgeon at UK HealthCare in the Department of Otolaryngology — Head & Neck Surgery.