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Nasal blockage

Nasal blockage is one of the most common ENT complain. Two main reasons are nasal septal deviation and inferior turbinates hypertrophy.

 

1. Nasal septal deviation - latin DSN (deviatio septi nasi) - nasal blockage is constant due to the cartilaginous and/or bony deformation. One nasal cavity is more narrow and the airflow is therefore permanently compromised. Local decongestants only little improve nasal breathing. The only effective treatment is surgical correction, most commonly under general anaesthesia.

 

2. Inferior turbinates hypertrophy - latin (hypertrophia conchae nasalis inferioris) - nasal blockage depends on body position and other factors. Lying position blocks more intensively one nostril due to raised hydrostatic tension. Changing position to sitting or standing or applying local decongestants improves nasal airflow. Chronic overuse of the decongestants develops rhinitis medicamentosa, which causes permanent nasal blockage. There are several treatment options, conservative being ineffective.

Turbinoplasty offers good solution and is available in several modalities -  nowadays cryosurgery, radiosurgery and laser are most commonly used. Cryosurgery in my opinion makes the least discomfort for the Patient. They are done in an out-patient settings under local anaesthesia. Their efficacy is similar and is estimated to be about 70-80%.

Cryosurgical turbinoplasty

Schemat przerostu małżowiny nosowej dolnej

I recommend to my Patients cryosurgical turbinoplasty - least invasive and least painful of all modern turbinate surgeries. There is no bleeding, the procedure last for about 20 minutes.

 

1. Local anaesthesia - lignocaine-soaked gauze to both nasal cavities for 5 minutes (optional)

2. Cryosurgical nasal probe is placed in the nostril on top of the turbinate, parallel to its long axis

3. First cold application 1,5 minutes (in this stage the probe adheres to the turbinate surface very firmly and can not be withdrawn)

4. 3 minutes break

5. Second cold application 1,5 minutes

6. End of procedure

 

Patient can feel some cold and discomfort immediately after cold application for 2-3 minutes in the lower nose and part of the chick. There is no bleeding.

 

For one week after the procedure, the turbinates are moderately swollen and some watery nasal secretion appears. After that time the turbinates become smaller as the remodelling process starts. By the time of two months, the process completes and the nasal airflow is significantly better.

 

The goal of the cryosurgery of the turbinates is to permanently augment the nasal airflow and to release the Patient from the need to use local nasal decongestants.

In some Patients the revision turbinoplasty can be required after some years, more commonly in case of allergy.

 

Rafał Chmielewski - ZnanyLekarz.pl