Featured Question

Dear Dr. Spector,

I was in a car accident about two years ago, and some glass shattered and hit my nose. It was cut pretty badly and I think it shattered a tiny piece of the bone. I use nasacort and it worked pretty well for a while, but recently it has become really hard for me to breathe. It feels as if my air passage is getting smaller. I plan on having it looked at by a specialist very soon. Do you have any suggestions on temporary relief? What is your advice?

Thank you for your time,

Sincerely,

Veera

Cary, North Carolina

Dear Veera,

After an accident that involves the nose, it is unfortunately very common to notice a decreased sensation of airflow through the nose, either immediately, or over time.

A true nasal fracture involves the nasal bone, which is the bony-hard area at the top one-third of the "bridge of the nose." This can obviously cause obstruction to airflow, especially if it is severe.

The remaining parts of the external nose below the nasal bone are very pliable. This part is called the "nasal septum" in the midline, and is composed of cartilage in the areas you can feel from the outside. It is also made of very thin bone in deeper areas not felt from the outside. The nasal septum continues vertically from the bridge of the nose to the roof of the mouth, and separates your nasal airway into two tunnels. It is the nasal septum that can be easily deformed or fractured during an accident such as yours, leading to a "deviated nasal septum." Even mild sporting injuries, that otherwise do not cause one to seek out medical attention, may deflect the septum to one side, causing a septal deviation, and the resultant nasal airway blockage. Once an injury such as yours occurs, it is common for scarring to progress over time, which combined with other "everyday injuries" produce a progressively more pronounced deviation, and hence a progressively worsening nasal obstruction. So, it is probably not your imagination that your airway is "getting smaller."

Other problems associated with a restricted nasal airway include increased snoring, daytime fatigue, nosebleeds, as well as issues such as bad breath and dental caries associated with continuous mouth-breathing.

The Nasacort you used is probably the best method of providing "temporary relief" by shrinking internal nasal tissues called turbinates, that hang from the outside walls of the nasal cavities, like a store-front awning. This nasal steroid, however, does little for the mechanical obstruction caused by the septal deviation. Other interventions, such as external strips sold commonly in drug stores may also provide some relief by pulling the other pliable cartilages of the nasal tip away from the deviated septum, and opening the nasal airway at its entrance. These devices, however, do not cure the problem, and must be used everyday for relief.

When I see a patient with this problem, and the above strategies have not provided continued benefit, as in your case, a procedure called a "septoplasty and turbinate reduction" has a very high chance of providing a dramatically improved nasal airway for many decades, and possibly permanently. This procedure is usually performed in a hospital under anesthesia, and involves, as you might guess, returning the nasal septum to the midline, and shrinking those other awning-like tissues inside the nose that can additionally block the airway. The procedure is outpatient, and usually only takes about thirty to forty-five minutes to perform. It is a surgical procedure, however, and does involve a few days of recovery, as well as the slight possibility of complications that are relatively rare in the hands of a qualified specialist.

In summary, you have largely exhausted any "temporary fixes" for your problem, and I would highly recommend keeping your appointment to discuss this problem. After confirming that a septal deviation is in fact the major cause of your nasal obstruction, a septoplasty and turbinate reduction will be an excellent option for you to consider.

Thank you for your question!

Jared E. Spector, MD

Back to Ask Dr. Spector

As a new feature of our website, we at Mann ENT would like to introduce "Ask Dr. Spector."

Dr. Spector is Board Certified in the specialty of Otolaryngology/Head and Neck Surgery, and will review all questions submitted through this website related to the specialty commonly known as "Ear, Nose and Throat."

This site is intended to help the public gain information on topics such as sinus surgery, allergy, snoring, voice problems, ear disorders, tonsillar problems, facial cosmetic procedures and so on, in order to foster a better understanding of the topic and to guide future evaluation.

At regular intervals, Dr. Spector will choose one question, and provide a thorough response. This response will be posted on this website for all to read.

The responses provided by Dr. Spector are for informational purposes only, and do not substitute for an actual consultation with a physician. An actual consultation would include not only a review of medical facts, but also a physical exam and medical testing.

Any information received from Dr. Spector through this website is not intended to diagnose, treat, or cure any medical problem.   Mann ENT, Dr. Spector and www.entman.com present all data as is, without any warranty of any kind, and is not liable for its accuracy, nor for any loss or damage caused by a user's reliance on information obtained on our site.

All information obtained from this site must be confirmed with a standard, in-office medical consultation with a qualified physician.