Nasal Congestion: Insights on Surgery and Treatment Options

Nasal congestion issues?

Hello Doctor, I am also a patient with unilateral nasal congestion that alternates.
After much thought, I would like to ask you a few questions.
The so-called nasal cavity expansion surgery seems to involve addressing the nasal septum, middle and inferior turbinates, and nasal valves, among others.
I have also seen that in foreign countries, they address nasal congestion related to sleep apnea by simultaneously treating the adenoids, middle (addressing the bubbles), and inferior turbinates, etc.
However, in Taiwan, it seems that only independent surgeries are performed.
I have heard doctors suggest that I undergo septoplasty and RF reduction of the inferior turbinates, but the results have been minimal, and I still experience congestion (with poor results from sprays and medications).
I frequently return for follow-ups, and doctors have noted the enlargement of the middle turbinates multiple times, but they only recommend another inferior turbinate surgery.
Aren't the middle turbinates and nasal valves also part of the nasal obstruction?
1.
I would like to ask if you perform any integrated surgeries similar to this?
2.
For the middle turbinate surgery addressing the bubbles, can it be done with laser treatment? I have heard that using a knife requires a hospital stay of 4 days and 3 nights, with a high pain index.
3.
When I inhale forcefully during nasal congestion, I feel that inhalation is relatively smooth, but exhalation is completely blocked.
Is this normal?
4.
Due to snoring and sleep apnea issues, my soft palate and other tissues appear normal externally, but upon endoscopic examination of the soft palate during the Müller maneuver, it was found to collapse significantly.
Therefore, I was advised to undergo a soft palate lift (not resection).
Is this type of surgery effective? Is there a chance of recurrence? Thank you.

Niming, 40~49 year old female. Ask Date: 2015/12/13

Dr. Zheng Jueyi reply Otolaryngology

Hello, the primary airflow in the nose mainly passes through the inferior turbinate.
Therefore, the main surgical interventions to alleviate nasal congestion focus on correcting the nasal septum and performing inferior turbinate surgery.
If it is confirmed that the middle turbinate has a cyst, it can be addressed using a scalpel or minimally invasive blade, as laser treatment is not applicable.
If a patient has undergone RF inferior turbinate reduction and still feels unsatisfied with the results, it is indeed reasonable to consider traditional partial inferior turbinate resection surgery, as it can create more space.
Regarding the issue of snoring, addressing the relaxation of the soft palate through soft palate lifting should provide some benefit.
However, if weight gain or aging leads to decreased tension in the soft palate, recurrence may still occur.
Wishing you safety and health.
Sincerely, Dr.
Jue-Yi Cheng, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2015/12/13

More Info

Understanding nasal congestion and its treatment options, especially in the context of surgical interventions, is crucial for patients experiencing persistent symptoms. Your inquiry touches on several important aspects of nasal surgery, particularly concerning the management of nasal obstruction, which can significantly impact quality of life.

1. Integrated Surgical Approaches
In many cases, patients with nasal congestion due to structural abnormalities may benefit from an integrated surgical approach. This could involve correcting the deviated septum (nasal septoplasty), reducing the size of the inferior turbinates (turbinate reduction), and addressing any issues with the middle turbinate or adenoids if they are contributing to the obstruction. While separate procedures are common, some centers do offer combined surgeries that address multiple issues in one operation. This can be more efficient and may lead to better overall outcomes, as it reduces the need for multiple recoveries and allows for a more comprehensive resolution of nasal obstruction.

2. Laser Treatment for Middle Turbinate
Regarding the treatment of the middle turbinate, laser techniques can indeed be employed. Laser surgery can be less invasive and may result in less postoperative pain compared to traditional methods that involve cutting with a scalpel. However, the choice of technique often depends on the surgeon's expertise and the specific anatomy of the patient. It's essential to discuss with your ENT specialist whether laser treatment is suitable for your case, as well as the expected recovery time and pain management strategies.

3. Breathing Mechanics During Nasal Congestion
Experiencing difficulty during exhalation while feeling some relief during inhalation is not uncommon. This phenomenon can occur due to the dynamic nature of nasal congestion, where inflamed tissues may obstruct airflow differently during inhalation and exhalation. The nasal cycle, which is a natural process where one side of the nose becomes more congested than the other, can also contribute to this sensation. If you find that your symptoms are significantly impacting your daily life, it may be worth discussing further diagnostic options with your physician, such as nasal endoscopy, to better understand the underlying causes.

4. Soft Palate Surgery for Sleep Apnea
As for the soft palate surgery, procedures like uvulopalatopharyngoplasty (UPPP) or soft palate lifting can be effective for some patients with obstructive sleep apnea (OSA). These surgeries aim to increase the airway space by modifying the soft tissues of the throat. The success rate can vary, and while some patients experience significant improvement, others may find that symptoms recur over time. Factors such as weight, age, and the presence of other anatomical issues can influence the likelihood of recurrence. It’s crucial to have a thorough discussion with your surgeon about the expected outcomes and potential for revision surgery if necessary.

Conclusion
In summary, managing nasal congestion often requires a multifaceted approach, particularly when surgical intervention is considered. Integrated surgical techniques may provide a more comprehensive solution, while specific treatments like laser surgery can offer less invasive options. Understanding the mechanics of nasal breathing and the implications of soft palate surgery for sleep apnea is essential for making informed decisions about your treatment plan. Always consult with your ENT specialist to tailor the approach to your specific needs and to ensure that all potential treatment options are explored.

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