Surgical Solutions for Nasal Obstruction

You’ve tried everything else to improve your nasal breathing, is surgery an option?

You have been plagued by nasal obstruction for a long time. It makes exercise (or trying to exercise) and sleep (or trying to sleep) difficult. Special pillows and sticky nasal strips, nasal sprays and antihistamine pills have failed to help. Nothing seems to get your nose open so you can breathe freely. Your N.O.S.E. score is through the roof (take the quiz at You need a serious approach for a lasting improvement. It has come to this: it is time to ask your doctor if surgery is an option.

Surgical solutions for nasal breathing problems

Wouldn’t it be nice to inhale freely and easily through your nose? Getting rid of that struggle and leaving behind mouth-breathing to get enough air is not a dream. There are procedures, both in-office and in the operating room, that can make the difference for you.

Surgery for enlarged turbinates.

Turbinates are normal structures on the sidewalls of the nose that function to warm, filter, and humidify the air we inhale on its way to the lungs. These are highly vascular structures around a bony framework; they tend to swell if irritated or inflamed. Sometimes that enlargement becomes permanent. If enlarged turbinates block you way to comfortable breathing there are several reduction options available.

  • Radiofrequency turbinate reduction (RFTR) is a highly successful, in-office procedure performed with only local anesthetic. A small probe is applied along the inferior (lowest) turbinates. The RF energy penetrates deeply to shrink and scar the soft tissue, reducing the space they take up in the nasal airway.
  • Coblation is a similar technique to the radiofrequency procedure. A low-temperature probe is again applied to the turbinate soft tissues to burn and reduce them. This approach can also be accomplished in the office.
  • Various techniques are used to reduce the size of turbinates, under general anesthesia, in an operating room setting. Partial turbinate resection, as the name implies, involves the physical removal of turbinate soft tissues and often even bone. Turbinate cautery is similar to the outpatient procedures in that the soft tissues are burned, often with an electrical current called a bovie. This is often coupled with another procedure called turbinate outfracture. The bony framework of the turbinate is crushed up against the nasal side wall moving it out of the airway. These are much more intrusive so you to be need to be asleep to tolerate them.

Surgery for a deviated septum

The nasal septum is the thin bone and cartilage that divides the inside of the nose in half. If it is deviated and it is causing nasal obstruction, surgery can straighten it to improve the nasal airway. (Side Note: if you have a deviated nasal septum and can breathe fine there is no need for surgery.) The crookedness in your nose may be due to trauma or you may have just been born that way. Either way, a procedure called septoplasty – often performed at the same time as a turbinate reduction – can relieve your congestion. Again, this is done in the OR under general anesthetic. Don’t worry, this is not a “nose job.” There are no changes to your appearance. It is a functional improvement in your nasal airway and should be covered by your insurance.

Nasal valve surgery

Sometimes the “nasal valve,” an area on the side of the nose above the crease but below the bones, is weak and collapsible. When you inhale forcefully this area is sucked in to obstruct your breathing, which can make you miserable. Most surgical techniques to repair this area are difficult and plagued with failure. Fortunately for you, research is ongoing to find a fix – and we are really close.

Risks of nasal airway surgery

All surgeries carry risks, and those described above are no exception. Bleeding, infection, and continued nasal obstruction are possible with any nasal airway procedure. Fortunately, complications are exceedingly rare and outcomes are almost uniformly excellent.

If nasal obstruction is interfering with your life, talk to your doctor.

About The Author: Mark T. Brown, MD, MBA is the author of the book Smarter Sleep: Real Answers, Science-Based Solutions, Healthier Sleep. He is the founder of Great Hills ENT and Sleep Lab, in Austin, Texas.

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