Sinus congestion can mean different things to different people. For some people, it means sinus pressure. For others, it means poor nasal airflow. Most ENT doctors refer to the problem of a stuffy nose or restricted airflow of the nose as nasal obstruction.

What causes nasal obstruction?

Several things can cause nasal obstruction. To understand the causes, it helps to first understand the structure of the nose. 

In the middle of the inside of the nose is a flat sheet of cartilage and bone. This is called the septum. On the sidewall of the inside of the nose is a strip of tissue called a turbinate. Everyone’s septum and turbinates are unique in size and shape–like a fingerprint. 

Most cases of nasal obstruction are caused by one of three situations:

1. Enlarged turbinates
2. Crooked septum
3. Both enlarged turbinates and crooked septum

What's a turbinate?

A turbinate is a strip of tissue along the lining of the nose. It can swell or shrink based on many factors. 

When swollen (or congested), the turbinate blocks airflow, leading to a "stuffy nose." When decongested, it permits airflow. 

The turbinate is responsible for the back-and-forth nasal blockage people experience. For instance, when you roll over in bed and one side of your nose opens and the other closes off, it's the turbinate swelling on one side and shrinking on the other that's responsible for this change.

What causes enlarged turbinates?

Turbinates vary in shape and size just like other parts of the body. In some cases, they're simply too big for the nose. In other cases, they're enlarged because of allergies or infection. Regardless of the cause, the oversized turbinate problem can be fixed through very simple, office-based procedures at Iowa ENT Center.

What causes a crooked (deviated) septum?

First, contrary to what some people may say, you don't have to have had a broken nose in order to have a deviated septum. The septum can warp or shift over time without ever having been injured. Of course, an injury to the nose–however slight–will predispose someone to develop a crooked septum, even if there's no change to the shape of the nose.

How do I know what causes my nasal obstruction problem?

The best way to find out what is causing a problem with nasal obstruction is to be seen by one of our ENT specialists. We'll listen to you, review your history and perform a thorough exam. This will help us diagnose your nasal obstruction problem so we can recommend treatment options.

How is situation 1 – “enlarged turbinates” – treated?

Enlarged turbinates can be treated through a simple office procedure called “turbinoplasty.”  This 15-minute procedure permanently reduces turbinate size and improves airflow. It causes almost no discomfort during the procedure. There's no post-treatment limitation in activity and no post-treatment pain. It's very effective.

How is situation 2 – “crooked (deviated) septum” – treated?

When the septum is severely deviated, the only option is a minor nasal surgery. This procedure is done under anesthesia, and patients go home the same day. No nasal packing is used, though a thin soft silicone sheet keeps the repaired septum stable. This is removed in the office a few days after surgery and is painless.

How is situation 3 – “crooked (deviated) septum and enlarged turbinates” – treated?

As in situation 2, the septum is repaired. The turbinates are also treated at the same time.

I know someone who had nasal surgery, and it didn’t help. Why?

There are a number of reasons for this, and our physicians occasionally hear this from new patients. In most cases, this results from the previous surgeon fixing the septum but ignoring the turbinate. Only through a comprehensive exam can the exact cause be determined.

Will my nose be packed for any of these problems?

No. Nasal packing, an application of gauze or cotton packs to the nasal chambers, is not used at Iowa ENT Center for any of these problems.

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