Complete Nose Blockage

There are some people who almost have no need for their nose.  They are not using it to breathe.  But if so, something is wrong.  Nature gave us a nose for a reason.  We are not supposed to bring air into our bodies through the mouth; the nose is the preferred route.  Long ago, it was established in laboratory experiments, that lung function improves when the air is delivered to the lungs through the nose rather than through the mouth. 

So what are the reasons for this complete nose blockage?  There are a limited number of reasons why the nose does not allow enough air through it.  The first is that the passages are blocked from a previous injury.  When the nose is injured, the support structures cave in, become crooked and become an impediment to airflow. The nasal septum is broken, crooked, deviated. Often the injuries occur when we are young and so the adult patient has no knowledge of “normal breathing.”  They have only known complete nasal obstruction.

Another common reason is nasal allergy, particularly when it is superimposed upon an architectural deformity such as uncorrected broken nose.  The lining of the nose is very sensitive to certain allergens in the air.  For some people in springtime it is grass and trees.  For others it is indoor mold.   Others have very specific sensitivity to ragweed pollen which only grows in certain parts of the country.  But whatever the offending allergens, the nose blocks up because the lining swells.  Two normal structures within the nasal passages called the inferior turbinates are particularly subject to this.   The two inferior turbinates are larger than the four other turbinates can expand to nearly twice normal size.  Such a blockage within the nasal passages has dire consequences for breathing.

If you combine a deviated nasal septum as part of an uncorrected nasal fracture or just because one was born with it, with nasal allergies causing swelling of the lining and particularly thickening of the inferior turbinates, you have the setting for very poor breathing.

There is good new about this sad story, however.  Modern techniques of surgical correction sometimes in concert with certain simple medications can make a huge difference.  One of the most rewarding things for a surgeon is to give a patient his breathing back.  And, incidentally, when you give the breathing back, you also give the sense of smell back.  Because if air does not enter the nose, the smell receptors high in the nasal passages are not activated and the sense of smell is non-functional.  People think that taste comes from the tongue in the mouth but the reality is that the tongue has very primitive sensors that detect only salt, sweet and bitter.  But the actual aroma of food, for example, comes when air passes through the nose and stimulates the olfactory nerve which carries the sensation of smell to the brain.  Now you know why “food does not taste very good” when you have a cold.  Colds are temporary.  Think about those people who have permanent blockage and never have the pleasure of smelling a blooming rose or even a great dinner dish.