Part 4

Surgical procedures to unblock a nose

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How to diagnose a blocked nose

Before considering surgical treatment, you need to be examined by a doctor, preferably one who has training in Ear, Nose and Throat medicine, and one who has access to the full range of kit required, including flexible direct nasal endoscopy, skin prick and blood allergy testing, CT and MRI scanning. 

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Blocked nose and the NHS

The NHS is still offering nose unblocking surgery, although this situation may soon change. Usually though, it will not be counted as urgent and the wait for clinic appointments and subsequent surgery can be many months. 
 

Surgical procedures to unblock a nose

These range from simple Kinetic Oscillatory Stimulation (KOS), performed bloodlessly and painlessly over 20 minutes during your lunch break, to functional septorhinoplasty, which can mean 2 weeks off work with a lot of bruising and postoperative discomfort.

 
Kinetic Oscillatory Stimulation

This technique uses a balloon inserted down the nose in clinic, which then blows up to a regulated pressure, and then oscillates (vibrates) fast for 10 minutes each side of the nose. This procedure needs to be repeated after 4 weeks, and then every year. It costs £495 with consultation, £395 without. Useful particularly in those with nose blockage of unknown origin. 

 

Laser Turbinectomy under local anaesthetic

Another lunchtime procedure, the nose is numbed by applying cotton wool soaked in cocaine solution (yes!) to the inside of the nose. This numbs the inferior turbinate bone sufficiently to be able to bloodlessly remove 3 or 4 mm of mucosa (lining) around the area of the nasal valve using the carbon dioxide laser in conjunction with a computerised pattern generator and coaxial suction. This is sufficient to significantly improve breathing, since flow is related to radius to the power of 4  a small increase in radius causes a big increase in flow. The removed mucosa (lining) will grow back after a few years and the procedure will then need to be repeated. Cost is £750 per side. 

 

Laser turbinoplasty

This procedure can only be performed under general anaesthetic, as a day case. Return to work is after 2 or 3 days. It is not painful, and uses the Holmium-YAG laser to partially remove the inferior turbinate bone at the level of the nasal valve, where the sensation of nose blockage is mostly felt. This is a more permanent effect than turbinectomy. Cost is £2300 for both sides. 

 

Septoplasty

Septoplasty is another operation under general anaesthetic as a day case. It is performed in order to straighten the cartilage separating both sides of the nose - the nasal septum. It is not a painful procedure, generally no packing is used inside the nose once the operation is complete, but the nose does feel congested for a week or so post operatively. 2-3 days off work are required. Cost is £3500, this may include sinus washout and turbinate out fracture. 

 

Functional septorhinoplasty

I perform this procedure in conjunction with Plastic Surgeon Alex Karidis. Please see his website for more information. 

 

Endoscopic Nasal Polypectomy

This is an operation performed to safely and effectively remove swollen mucosa called polyps, from the nose. It needs to be performed in conjunction with intensive anti inflammatory medication in the form of sprays, tablets and depot injections. The procedure is performed under general anaesthetic using telescopes inside the nose to get a good view. It is a day case, not painful and usually no nasal packing is required after the operation is complete. 2 or 3 days off work are required. The cost is £3600.

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