Having a blocked nose is a very common symptom in the adult population of the UK. It is often difficult to tolerate for many patients, since they have to breathe through their mouths much of the time. This can cause excessive dryness, which can damage the gums, and sometimes cause drooling. Mouth breathers tend to be slow, noisy eaters and the blocked feeling itself is often highly off-putting, affecting the ability to exercise and function normally. Sense of smell and taste can also be affected.
Mr. Mike Dilkes provides the most current, optimal testing and treatments for blocked nose, based on medical research and consultations with leading experts in the USA and Germany.
Snoring is common in those with a blocked nose, as an open mouth causes the mandible (jaw bone) to move backwards. This means the tongue, which is attached to the mandible, also moves backwards, thus obstructing the space behind the tongue — which is by far the commonest site for snoring. Nose blockage may also be associated with sneezing and a runny nose (rhinitis). The “Nasal Cycle” always means that one side of the nose will be open, the other relatively blocked, from time to time and side to side during the day and night. The problem therefore arises when the side that should unblock during the nasal cycle, can’t. Then the nose becomes totally blocked. Allergy, humidity, air temperature, stress, etc., can all be associated with a blocked nose.
The paranasal air sinuses (“sinuses”) are commonly diseased when the nose is not functioning properly, causing acute and chronic sinusitis, post-nasal drip, bad taste and smell, plus a chronic dry cough.
Indications for blocked nose surgery
We perform surgery for nose blockage when medical therapy has been exhausted, or when the patient feels he or she does not want to take medication for a lifetime.
Causes of blocked nose
There are many causes of a blocked nose. The three commonest ones are allergy, a deviated nasal septum and chronic rhino-sinusitis.
Treatment usually starts with simple application of steroid or antihistamine sprays, or a combination of the two. Anti-cholinergic sprays may help when the main symptom is a runny nose. If initial advice and sprays have not solved the problem, the next stage in treatment is with tablets containing antihistamines, anti-leukotrienes or steroids. Depot injections of steroids can be given in chronic conditions such as nasal polyps. Allergen (what you are actually allergic to) avoidance is a vital part of treatment, so allergy testing is a must. In cases of severe specific allergy, a desensitisation course can also be tried. Allergy testing can take many shapes – see the section on allergy.
Deviation of the nasal septum is caused by trauma. The actual incident may not be recollected by the patient. It can be part of birth canal trauma when you are born. Symptoms of nose blockage due to this tend to appear as we get older, even though the damage may have been caused at an earlier age.
Sinus disease occurs due to obstruction of the normal sinus outflow tract from the para nasal air sinuses into the nose. This outflow tract clears mucous produced by the sinuses, through tiny holes (ostia) into the nose cavity, where they are cleared by passage backwards into the throat, and swallowing. Over a litre a day of mucous is produced by the nose and sinuses. Over-production causes symptoms of postnasal drip and chronic cough. Nose polyps can be a side effect of this, and they cause complete nose blockage with loss of sense of smell. Acute sinusitis occurs when the ostia are blocked (e.g. after a cold), fluid then builds up in the sinuses, which subsequently becomes infected. This type of infection can be very serious, sometimes life-threatening.
People suffering from chronic stuffy sinuses can get their problem treated through simple procedures other than surgery. An interesting approach – a balloon that is inflated inside the nose – is a 30-minute procedure that has received an endorsement from the National Institute for Health and Care Excellence (NICE).The procedure is carried out with the Xpress multi-sinus dilation system, which is a device described as looking like “a small pistol” with a flexible wand at the end.
The wand is gently directed into the nasal passages, then a button is pressed to inflate a small balloon in the sinus opening to gently expand it – allowing relief of sinus obstruction. The balloon creates little tears and fractures that heal with time reducing leaving the sinus opening wider and better functioning than before .
Additionally, the Xpress has a built-in LED lighting which makes it suitable for the outpatient setting.
A significant number of patients get long-lasting relief from the symptoms of sinusitis.
Surgical Treatment of Blocked Nose – Septoplasty
This is quite a common procedure, where a bent nasal septum is corrected. It is a day treatment under a short general anaesthesia. Our readmission rates and overnight stay rates are less than 1%. Successful unblocking occurs in most patients after one attempt, although a small percentage (around 1:40 patients) need a second procedure. Antibiotics are prescribed post-operatively to prevent infection or bleeding.
Return to work is usually around 48 – 72 hours post treatment. Painkillers are not usually required post-operatively. There are no black eyes or cuts on the outside, as it’s all done internally. Patients hate having packs removed from the nose after surgery. We do away with this by using laser techniques on the turbinates (which would otherwise be prone to bleeding) and we insert dissolving packs which do not need to be removed (they dissolve over 48 hours). It’s like having a cold afterwards, as the nose swells up inside for about 1 week post-op. This is alleviated by using decongestant (Otrivine) sprays, and salt water douches (Sterimar).
Laser Reduction of the Inferior Turbinates
The inferior turbinates are bony structures covered by nasal lining, which protrude into the nose and can be a cause of nose blockage. Inferior Turbinate reduction with the carbon dioxide laser is a popular procedure, as it can be safely and quickly performed under local anaesthetic – using cocaine solution on cotton wool. This procedure vapourises away the nose lining over the turbinate. This lining re-grows, and can cause further blockage 18-24 months post op – when it can be safely repeated, if required. The other technique for reduction of the inferior turbinate is called Turbinoplasty. This is performed under general anaesthetic, and uses the Holmium-YAG or CO2 laser to remove part of the inferior turbinate bone. This is a much more permanent effect. Packs are generally not needed with either procedure, and patients can return to work the same day if it’s the local anaesthetic technique, or after 48 hours if it’s the general anaesthetic.
The pre-treatment diagnosis also often involves a CT scan of the sinuses, and full endoscopic examination of the nose. The procedure works by altering the function of nose breathing receptors, and reducing the size of the turbinates, thus increasing the size of the breathing channel and reducing the ability to sense blockage.Vaser reduction of the inferior turbinates