Nasal Disorders - Symptoms
Deviated Septum (Crooked Septum)
The nasal septum is the center part of the nose which divides the nose into two nostrils. The septum extends about 3 inches back from the front of the nose. The septum may become crooked (deviated) by an injury to the nose as a child or an adult. Even a small injury as a child can lead to a minor curve of the septum. When the nose begins its major growth spurt during the teenage years, the minor curve of the septum can grow much worse. Sometimes the deformity of the septum can be seen or felt, but more frequently, the curvature is further back and can’t be seen by the patient. Only a complete examination of the nose after spray of a decongestant spray can determine if the septum is deviated. A very small curve of the septum can create a significant amount of nasal obstruction (Airway resistance increases by the 4th power of the radius of the airway).
A deviated septum may cause difficulty breathing through the nose on one or both sides. Frequently the obstruction will seem to alternate between sides. If the right side of the nose is blocked, the patient will usually be more comfortable sleeping on the right side. With a deviated septum, one may also experience post nasal drainage, nose bleeds, and scabbing in the nose (more commonly called boogers). People with a deviated septum may also be predisposed to recurrent sinus infections.
Turbinate Enlargement (Hypertrophy)
The nasal turbinates are structures within the nose which moisturize and warm the air as you breathe. There are three turbinates on each side of the nose (a lower, middle and upper turbinate). As the air flows past the turbinates, the air is warmed up and humidified so that once the air gets to the lungs, it is more comfortable. The turbinates may enlarge due to a deviated septum, allergies, non allergic rhinitis or sinus infections. The turbinates are made of a central flat piece of bone surrounded by blood vessels and a skin (mucosa) lining. Enlargement may be due to enlargement of the bone or skin lining or a combination of both. The middle turbinate may also enlarge due to a sinus or air pocket that can grow into the turbinate (also known as a concha bullosa).
When the turbinates enlarge, they cause nasal congestion and difficulty breathing. The patient usually describes a sense of swelling or mucous in the nose but may not be able to blow anything out. Enlarged turbinates can block the nose and cause difficulty breathing mouth breathing and snoring. If the turbinates remain enlarged, they can predispose to sinus infections due to obstruction of the sinuses. Turbinate enlargement may cause difficulty breathing through the nose on one or both sides. Frequently the obstruction will seem to alternate sides.
Nasal Valve Collapse or Stenosis
The nasal valve is the area of the nose which is the smallest part of the nasal airway. The valve corresponds to the crease on each side of the nose, just above the nostril. If you breathe in very hard through one side of the nose, this portion of the nose will tend to collapse inward and will nearly close off the nasal airway. However, in a person with nasal valve collapse (stenosis or narrowing), the valve will close off with minimal effort. Frequently, nasal valve collapse or stenosis will be caused by a prior rhinoplasty (nose job). By making the nose smaller, some of the supporting tissues of the nose may be removed, and lead to collapse of the valve. Nasal valve collapse may also occur in people with a deviated septum and enlarged turbinates.
A person with nasal valve collapse will usually feel that breathing is better by pulling outward on the cheek or lifting up on the tip of the nose.
Nasal polyps are fleshy growths that protrude from the nasal or sinus membranes. Most nasal polyps are benign growths and are due to inflammation or infection in the nose or sinuses. In some people, nasal polyps are hereditary. Rarely, nasal polyps may be cancerous. The main symptom from nasal polyps is nasal obstruction and congestion. Patients with polyps may also have post nasal drainage, facial pain and pressure and are frequently prone to sinus infections.
Injuries to the nose may lead to fractures of the nasal bones or the septum. The two nasal bones form a triangular structure while the septum sits in the middle like a pole holding up a Teepee. With an injury, either one or both nasal bones may fracture leading to a deformity, bruising, swelling, pain, bleeding and difficulty breathing through the nose.
Deformities of the nose are usually caused by prior injury, though in some cases will be congenital. External deformities can also lead to difficulty breathing through the nose due to narrowing of the nostrils. A deformity of the nose may be caused by deformities of any portion of the nose including the nasal bones, the nasal septum, or any of the nasal cartilages that contribute to the shape of the tip of the nose (upper lateral cartilages, lower lateral cartilages, lower medial cartilages).
Nose bleeds (Epistaxis)
Nose bleeds are caused by a rupture of a blood vessel in the nose. The blood vessels in the nose are very close to the surface of the nasal lining. Any minor trauma to the nose can tear the nasal lining and rupture a blood vessel. The more common causes of bleeding are blowing, rubbing, or picking the nose, and sneezing hard or frequently. If a blood vessel starts to bleed, it will usually stop when a small scab forms over the area. The area will usually heal completely in about 2 weeks. However, there is a tendency to re-bleed if the scab should come off too early, before healing is complete.
Nose bleeds are more common in people with a deviated septum, allergies, sinus infections, or during the winter when the air in the house is dry. The majority of nose bleeds are from a blood vessel on the nasal septum at the front of the nose. Older people tend to get bleeding from a larger blood vessel that ruptures at the back of the nose.